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Associated Building Permit #
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Worksheet for Fire Permit Application
City of Newport Beach - Building Division
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, /V r ❑ire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name _ _ ��•Y, �. # Units I
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2. Description of Work
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Valuation $
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Extg Sq Ft F New/Added Sq Ft Total Sq Ft
Architect/Designer's Address Architect/Designer's E-mail Address
# Stories
17New ❑Add ❑Alter ❑Demo
❑ 5. Engineer's Name Last First F77-1
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last L mm" First
Owner's Address Owner's E-mail Address
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City _ �Iri _ State Zip Telephone
❑ 4. Architect/Designer's Name LastFirst
Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City I State Zip Telephoned
❑ 5. Engineer's Name Last First F77-1
Lic. No.
Engineer's Address Engineer's E-mail Address
City— -71 State Zip Telephoned
❑ 6. Contractor's Name Last Af=\ ' � V First E77-71 Lic. No.
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Contractor's Address Contractor's E-mail Address
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City—�M,/�bOW State I /' /► Zip 1,0 d I Telephone^
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OFFICE USE ONLY PERMIT NO.
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TYPE OF CONSTRUCTION PLAN CHECK NO. 24r0d t
OCCUPANCY- GROUP PLAN CHECK FEE $