HomeMy WebLinkAboutF2018-0503 - Permit Application2tRS-,as Vg�g•o5o3
Print 1 orm Worksheet for Fire Permit Application g City of Newport Beach - uilding Division
Please print 3 copies
Associated Building Permit # x.{/18 - 02rat, ire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. Project Address(Not mailing address) Floor Suite No
Tenant Name # Units
2. Description of Work
Owner's E-mail Address
Use
y `
City __ I\tb I
Valuation $
Extg Sq Ft New/Added Sq Ft � Total Sq Ft
❑ 4. Architect/Designer's Name Last
# Stories
New ❑Add F] Alter r7 Demo
No.
Check Appropriate Box for Applicant/Notification
[] 3. Owner's Name LastLAp—VFirst
Owner's Address
Owner's E-mail Address
City __ I\tb I
State F__7
Zip —_ Telephoned
❑ 4. Architect/Designer's Name Last
First Lic.
No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City _
State
Zip E__71 Telephoned
❑ 5. Engineer's Name Last
st Lic. No. C�
Engineer's Address
Engineer's E-mail Address
City
State
Zip Telephoned
❑ 6. Contractor's Name Last
First �1t� Lic. No. ''lam
Class F -t
Contractor's Address
Contractor's E-mail Ad ress
City ,\
State
Zip `` Telephone
OFFICE USE ONLY
PERMIT NO. �'iAl
(75O 3
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $
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