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City of Newport Beach Fire Permit Application�i
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1
Project Address
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Number and Street suite/unit
zip
Associated Building Permit #
Owner/Tenant
2
Name
I S
3 Scope of work/
misc. description
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New
Construction TI Addition Alteration
Demolition
'Check one
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3 Number of Stories
Commercial Fire Sprinkler
Number of Heads
per building
13 LJ13R 13D
Multi -Family (3+units) 171 Fire Alarm
Number of Devices
Number of
Dwelling Units
Residential (1-2 units) nFire Underground
O Number of Risers
*Check one rj Fire Misc.
-Write in accurate count
'describe above
4 Applicant Information Name:
Address:
Phone#: Email:
Check if same as Contractor
Designer Information Name:
Address:
Phone#: Email:
Check if same as Contractor
Contractor Information Name:
Address: ZZL -�7
Phone#: e01-6L(7 j61 Email: �oit.6Usl�,
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License#: -0 55g9 Class: &-I(,
Office Use
Permit T.��� �� Plan Check Permit/Plan
Number Y Number Check Fee $
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