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City of Newport Beach Fire Permit Application
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1
Project Address
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NumberandStreet suite/unit
Zip
Associated Building Permit #
2
Owner /Tenant Name
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3
Scope of work/
mist. description
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New
Construction TI Addition Alteration Demolition
*Check one
Commercial Fires rink r
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Number of Heads
Number of stories
per building
13R ' 13D
❑Multi -Family (3+units) ❑ Fire Alarm
M[lumber of Devices
Number of
❑Residential (1-2 units) FIFire Underground
0 Number of Risers
Dwelling Units
*Check one M Fire Misc.
*Write in accurate count
*describe above
4 Applicant Information Name: ,1 ►YCS, SP(1l1�(�lttiC �j�5�%��[
Address: Gig 2L OL)I/un-
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Phone#: Oa& _ 6579' Email:
Check if same as Contractor
Designer Information Name:
Address:
Phone#: Email:
QCheck if same as Contractor
Contractor Information Name: c�e, �6.4`j Z6I
Address:
Phone#: Email:
License#: Class:
Office Use
Permit Plan Check Permit/Plan
Number Number Check Fee $
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