HomeMy WebLinkAboutF2018-0575 - Permit Application0�E.wron'
Worksheet for Fire Permit Application04
City of Newport Beach - Building Division
Please print 3 copies ""°"'°r
Associated BuiIdin Permit# _ ❑ Fire Sprinkler j '� Fire Alarm ❑Fire Misc
Suite No
1. Project d ;?ass (Not mailing address) Floor Suite
#Units
Tenant Name
2. Description of Work
Use
Valuation $ L V v l
Extg Sq Ft New/Added Sq Ft Total Sq Ft
���
# Stories I 1 5�.�
I.—J
❑ New ❑Add ❑Alter ❑Demo
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name- Last 1.1�� tFirst��
Owners Address Owner's E-mail Address
II/I II -
City State �] Zip Telephone's
LLL
❑ 4. Architect/Designer's Name Last First I J
Lic No. J
Architect/Designer's Address Architect/Designers E-mail Address
city State � J Zip �I Telephone
I
❑5.F_ngineer'sName Last -`. First _ Z(G
Lic.Na�
Engineer's Address Engineers E-mail Address
1 L
/-
City G_�j�j�f=�. _ j State C. Zip vtl Telephone
P
❑6. Contractor's Name Last U Lic No. Class —I
- - -....t -._...
Contractors Address Contractors E-mail Address
— I
City I State—J Zip I Telephone-
------
OFFICE USE ONLY PERMIT NO.
i TYPE OF CONSTRUCTION PLAN CHECK NO.
7j� �, lJ
OCCUPANCY - GROUP PLAN CHECK FEE $