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Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
V, Fire Sprinkler r Fire Alarm F- Fire Misc
1. Project Address (Not mailing address)
I I �'t p, . �- N\,. e.:s�
Tenant Name
2. Description of Work
Extg Sq Ft F— New/Added Sq Ft Total Sq Ft
F_ New r" Add r Alter r Demo
Check Appropriate Box for Applicant/Notification
1-4;
Floor Suite No
# Units
Use
Valuation $ S I
# Stories 1
F_ 3. Owner's Name
Last
FirstF
Owner's Address
Owner's E-mail Address
City
State �—'
Zip �— Telephonel�
F_ 4. Architect/Designer's Name
Last
First Lic. No.
F—
ArchitecUDesigner's Address
Arch itecUDesigner's E-mail Address
City
State F_
Zip F_ Telephoned
I— 5. Engineer's Name
Last
First F_ Lic. No.
F_
Engineer's Address
Engineer's E-mail Address
City
State F—
Zip F_ Telephoned
—6.Contractor's Name Last
����� First M�! Lic. No. �760�Class c-)
Contractor's
Contractor's E-mail Address
[Address L
City L, \L�
State (
Zip (� L3 ( Telephone'' 4 6 _S 3 u
OFFICE USE ONLY
PERMIT NO.
TYPE
/qo
"" �Z
p t
�y AA
OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $