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City of Newport Beach Fire Permit Application
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Project Address c�
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Number and Street suite/unit zip
Associated Building Permit #
Owner / Tenant
Name
Scope of work/ yt' �r _ 1c o r. c s ol= a n &,J
mist description
New TI Addition Alteration Demolition
Construction
*Check one
Number of Stories per
Commercial Fire Sprinkler Number of FS Heads building
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nMulti-Family(3+units) n Fire Alarm n Number of FA Devices Number of Dwelling
Units
Residential(1-2 units) n Fire Underground Number of Risers
-Check one El Fire Misc.
*describe above
*Write in accurate count
4 Applicant Information Name:
Address:
Phone#:
Email:
OCheck if same as Contractor
Designer Information Name:
Address:
Phone#:
Email:
Check if same as Contractor
Contractor Information Name: (?�Ct�e r��
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Address:-, 2 -
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Phone#:7iv-G/6- ii� Email: ev, 4!e-i6-�er;,,ra�,�_eTr%��
License#: --�k-& qG_
Class: C-I&
Office Use
Permit
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Plan Check
Permit/Plan
Number
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Number
Check Fee $