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Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
1. Project Address (Not mailing address)
(Sot 5 L)P2d~ o
Tenant Name 9(Li ` d F-t S I 1 'K CL
2. Description of Work 4
Extg Sq Ft F— New/Added Sq Ft
j— New r Add q Alter F_ Demo
r Fire Sprinkler JZ Fire Alarm r Fire Misc
Check Appropriate Box for Applicant/Notification
Total Sq Ft
aP.' MJ
U S
C4<�cOPN�P
Floor
Suite No
# Units
F—
Use
Valuation $ 1 Z)I, O np
# Stories F
f3. Owner's Name Last S14 wl 4 r,)
First , � j v
Owner's Address
Owner's E-mail Address
City CO/ _ GW-e 5a
State C
Zip 97 Telephone I?L�
If4. Architect/Designer's Name Last
m� Q
First 1 s ••! ii_.L_ Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
t-151v C
N2 elYn^ew5;nres;NV,GaW
City I f tNQ 21 �
State I CA,
Zip Fla 96-7 Telephone)) 5 1 (o LJ
I— 5. Engineer's Name Last �
First F Lic. No. �—
Engineer's Address
Engineer's E-mail Address
City
State F_
Zip F_ Telephoned
[ 6. Contractor's Name Last 1 5 f0 t I First �G,Ly, .o Lic. No. ]C�+J Class C�
Contractor's Address
Contractors E-mail Address
3151 Mil_w
5{-eve_ Q P�9-Xd*'(_0A icy iOM
City 04 2 5�
State RKA
Zip �/' (Ot�& Telephone 9 yQ _ C174.- j (p 110
OFFICE USE ONLY
PERMIT NO. 1.t tb •oz�31
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $