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Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Il Fire Sprinkler F_ Fire Alarm F- Fire Misc
1. Project Address (Not mailing address)
c •n
J01 c,M wlj ritiL.
Tenant Name
2. Description of
Work
K_,1tCa.l t' 44 Art yr,r 1e( 9A I•
Extg Sq Ft r',,,,,,---,,,rrrNew/Added Sq Ft �— Total Sq Ft _1,4 3 _
F_ New F_ Add y Alter r Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
# Units
Use l~
Valuation ,7
# Stories F
r 3. Owner's Name Last
First.
Owner's Address
Owner's E-mail Address
City
State F— Zip
F_ Telephoned
F 4. Architect/Designer's Name Last
RAM 7 VA First ��, «{�.,� Lic. No. gY'j �S
Architect/Designer's Address
Architect/Designees E-mail Address
1560 1—&&eVilt.- A", (03
w167
City
State t-A' Zip USER Telephone / �3C
F_ 5. Engineer's Name Last I
First Lic. No.
Engineer's Address
Engineer's E-mail Address
City I
State F_ Zip F_ Telephoned
6. Contractor's Name Last Haw i vri First lma,g Lic. No. b r; ass Class (--/E
Contractor's Address
Contractor's E-mail Address
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7-1060 �pn Cob�'L _.�VG Sw, _..
ti-q Ol M -M "},7H� V'nki . tbm
City I (11vrr/f
State i64 Zip q'2SEZ-_ Telephone/�� 3/j ZU�fJ
OFFICE USE ONLY
11 r� I Q � PERMIT NO. e
y
TYPE OF CONSTRUCTION
�4 1l � PLAN CHECK NO.
OCCUPANCY - GROUP
Z
-1 l PLAN CHECK FEE $