HomeMy WebLinkAboutF2018-0378 - Permit Application (2)Fj Lg
Worksheet for Fire Permit Application
Print Form City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # Fire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. Project Address
Tenant Name
2. Description of Work
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Extg Sq Ft �� New/Added Sq Ft �/ 3�-{ Z Total Sq FtF� 3 L( -z
VNew ❑ Add ❑ Alter ❑ Demo
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last C�r CPQ First
Floor Suite
# Units
Use /-/oust
Valuation$ �iDUU�
# Stories
Owner's Address Owner's E-mail Address
1'32s rU t2�C S� SFS l C�
City State Zip Telephone ?1y 650-3-1I(,
❑ 4. Architect/Designer's Name Last I 'Sc lit rimed a First Fa� Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
132-5_ AJ ?eek Cbuwt S�She ICS f�e1 F 61 jy�rd ( �+t
City State �'� Zip Telephone 2f4 (n"$p-341'
❑ 5. Engineer's Name Last r&1 7 First ��}Lic. No.
Engineer's Address Engineer's E-mail Address
132 dpi ��! �t s� Sfe CO F
City (��y� State Fc -k-7 Zip � Telephone
❑ 6. Contractor's Name Last �� y -,, J e r First y � j� Lic. No. '2� � Class C (�
Contractor's Address Contractor's E-mail Address
1325 k ' Car yr t S� She l c� lici �s FRR �u t . c o
City i� Vl4�l State Zip Telephone C7�5qi
OFFICE USE ONLY
TYPE OF CONSTRUCTION —
OCCUPANCY- GROUP
PERMIT NO.
PLAN CHECK NO.
3 PLAN CHECK FEE $