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Please print 3 copies
Associated Building Permit #
Wortssheet for Fit`e-Ptrmit-Application
City of Newport Beach 10
-Building Division
U i
F Fire Sprinkler F_ Fire Alarm F_ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name # Units �-
2. Description of Work
Use
Extg Scl Ft —__ New/Added Scl Ft F ----- Total Scl Ft I� -- Valuation $ Fc d
i- New r Add F- Alter F Demo # Stories F_
Check Appropriate Box for Applicant/Notification
F 3. Owner's Name Last 6,1, 4k__
First
Owner's Address Owner's E-mail Address
City State F— Zip [_ Telephone[�
7 4. Architect/Designer's Name Last �� �q Firs Lic No. �—
Architect/Designer's Address FTN
Architect/Designer's E-mail Address
City State �— Zip [_ TelephoneF—
F 5. Engineer's Name Last First F_ Lic. No. �—
Engineer's Address Engineer's E-mail Address
City
F 6. Contractor's Name Last
Contractor's Address
City
OFFICE USE ONLY
TYPE OF CONSTRUCTION
OCCUPANCY - GROUP
State �- Zip �— Telephone[-
First
Lic. No.� classF
Contractor's E-mail Address `"�11 ��J��,,�J
State �— Zip �— Telephonef �
PERMIT NO. j LIV rII v t el
PLAN CHECK NO.
PLAN CHECK FEE $