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Ic6 `O Z�� Worksheet for Fire Permit Application of m�
Cit Newport Beach - Building Division
Please print 3 copies ;,,,��r
Associated Building Permit # F ( Fire Sprinkler �j Fire Alarm f Fire Misc
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1. Project Address (Not mailing address) Floor Suite No
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Tenant Name�} -��
Units
2. Description of Work
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Use
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Extg Sq Ft F New/Added Sq Ft F Total Sq Ft p
Valuation $
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New r Add r Alter F_ Demo
# Stories
Check Appropriate Box for Applicant/Notification
F, 3. Owner's Name
Last XAOQ— /Owl First
Owner's Address
net's E-mail Address v l
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City .i/�1L1 /�'c _.. (,r7fe%'1 State _... [�j ZiP q�tP ) Telephone1 ?41— 378- CJO �a
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F_ ATchitet igner's Name ast Pie First Ljtt ty Lic. No. F'
Architect/Design is Address
Architect/Designer's E-mail Address
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city
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State Zi i
P Telephone
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i 5. Engineer's Name
Last First F_ Lic. No. F_
Engineer's Address
Engineer's E-mail Address
City --
StateF Zip —, Telephone( .-
r6.Contractor's Na aLast (5f�oJ,4,,vv First t-50-1rz Lic. No. /,j�t�.. Class
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Contractor's Addres
Contractor's E-mail Address
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City
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State �yp� Zip (.2%,J.�—' Telephone777
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OFFICE USE ONLY
�e 2v PERMIT NO. GV
TYPE OF CONSTRUCTION
PLAN CHECK NO.
MRCUPANCY - GROUP
%r j C{ �/1� PLAN CHECK FEE $