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City of Newport Beach Fire Permit Application
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Project Address
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Number and Street suite/unit
zip
Associated Building Permit # /-) Z7Y -7
Owner / Tenant
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Name
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Scope of work/
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misc. description
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TI Addition Alteration Demolition
Construction
*Check one
Number of Stories per
Commercial Fire Sprinkler
Number of FS Heads
building
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1 1Multi-Family(3+units) n Fi re Alarm
Number of FA Devices ❑ Number of Dwelling
Units
nResidential(1-2 units) F_JFire Underground
n Number of Risers
*Checkone El Fire MisC.
'Write in accurate count
'describe above
4 Applicant Information Name: r—cl �r/✓ �� �.
Address: /c/77� �c � 4,
Phone#: 9—/y.-/7�i Email:
Check if same as Contractor
Designer Information Name:
Address:
Phone#: Email:
Check if same as Contractor
Contractor Information Name:
Address:
Phone#: Email:
License#: Class:
Office Use Permit 1 Plan Check Permit/Plan
Number Number Check Fee $
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