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City of Newport Beach Fire Permit Application
1
Project Address
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Number and Street suite/unit
zip
Associated Building Permit# YL ZOZk{ — 01—)Z,
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Owner / Tenant
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Name
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Scope of work/
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mist. description
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Construction TI Addition Alteration
Demolition
'Check one
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Number of Stories
Commercial Fire Sprinkler
Number of Heads
per building
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Multi -Family (3+units) M Fire Alarm
Number of Devices
U Number of
Dwelling Units
IM Residential (1-2 units) Fire Underground
0 Number of Risers
-Check one rj Fire Misc.
`Write in accurate count
*describe above
4 Applicant Information Name:
Address:
Phone#: Email:
0 Check if same as Contractor
Designer Information Name:
Address:
Phone#: Email:
TCheck if same as Contractor
Contractor Information Name: �7tjT&-Y-F4cr
Address: .735U ScG�I^Q, I"t
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Phone#: y�7 3�S 4G,u;, Em il:ISrilc
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License#: Class:
Office Use
Permit Plan Check Permit 1 Plan
Number Number Check Fee $