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Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
N Fire Sprinkler F_ Fire Alarm r- Fire Misc
1. Project Address (Not mailing address)
l ZLO rI an " S � t
Tenant Name � ��-� ( T o c
2. Description of Work J l�
Extg Sq Ft F New/Added Sq Ft F Total Sq Ft
i! New r Add x Alter r Demo
%,necK Appropriate 130x Tor Appiicant/Notitication
Floor Suite No
# Units F—
Use
Valuation $
# Stories 1 1
F_ 3. Owner's Name Last
FirstFOwner's
Address
rs E-mail Address
tne
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City State Zip Telephone�—
F_ 4. Architect/Designer's Name
Last G First
Address
Architect/Designer's E-mail Address
7Lic.Architect/Designer's
City or9
StateFW Zip G�TelephoneJ
r 5. Engineer's Name Last
FirstF_Lic. No. �—
Engineers Address
Engineer's E-mail Address
City
State F_ Zip F— Telephonel—
F_ 6. Contractor's Name Last First F— Lic No. � Class Qo
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Contractor's Address
"� I hG Contractor's E-mail Address
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Tall al"dhtz-7 I
City R,
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State — Zip �� ]/, 1 Telephone '/� /) -
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OFFICE USEEONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NOTCZ60025 9i6
OCCUPANCY - GROUP
PLAN CHECK FEE $