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WORKSHEET FOR BUILDING FIRE PERMIT APPLICAT
PXRB,OR RESOURCES DIV.
:;ACH
CITY OF NEWPORT BE CITY OF NEWPORT BEACH
BUILDING DEPARTMENT
PLEASE PRINT OR TYPE FLOOR SUITE NO.
1. PROJECT ADDRESS OT MAILING ADl,ESS)
LEGAL DESCRIPTION No. UNITS
LOT BLOCK TRACT
2. DESCRIPTION OF WORK -p- c(,P- ce -e Y rz q USE-mc-ck 344-t
OF STORIES
VALUATION $3 96,
NEIN ADD Fl ALTER DEMO SO FT
mmr Cn - (NEWIADDED/B(TG)
Check Appropriate Box
n.*3. OWNER'S NAME LAb
0
Is
OWNER'S ADDRES
19. sr
OWNER'S E-MAIL ADDRESS
'CITY STATE
ZIP
PHONE NO.
—,3
Fj 4. ARCHITECT/DESIGNER'S NAME LAST
FIRST
LIC. NO.
I
ARCHITECT/DESIGNER'S ADDRESS
ARCHITECT/DESIGNER'S E-MAIL ADDRESS
CITY STATE
ZIP
PHONE NO.
Fj 5. ENGINEER'S NAME LAST
FIRST
STATE LIC. NO.
ENGINEER'S ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE
ZIP
PHONE NO.
n6. CONTRACTqA�S'NAME --
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STATE LIC.
705-41ass /�L
CONTRACTOR'S ADDR S
CONTRA R'S
STATIf J_
ZIP
PHONE NO.
OFFICE USE ONLY
TYPE OF CONSTRUCTION
OCCUPANCY- GROUP
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEE $
PLAN CHECK ENG.
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