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City of Newport Beach Fire Permit Application
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Project Address
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Nu berandStr et suite/unit
zip
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Associated Building Permit # ) L�ly_A_aL b
Owner / Tenant
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Name
3 Scope of work/
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mist. description
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New
construction TI Addition Alteration Demolition
Check one
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Number of Stories
Commercial Fire Sprinkler
13 umber of Heads
per building
13R 13D
❑Multi -Family (3+units) ❑ Fire Alarm
❑Number of Devices
13 Number of
Dwelling Units
❑Residential (1-2 units) ❑Fire Underground
❑ Number of Risers
*Check one ❑ Fire Misc.
*Write in accurate count
*describe above
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4 Applicant Information Name: G +b � ,) IhU
Address: U
Phone#: ) G Email:
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Check if same as Contractor
Designer Information me:
Address:
P one#: Email:
Check if same as Contractor
Contractor Information Name:
Address:
Phone#: Email:
License#: Class:
Office Use
Permit Plan Check pPermit) Plane,
Number Number �/ q V�� v ?�! O� - Check Fee $