HomeMy WebLinkAboutF2012-0059 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Department 0,,?58-,201,2
Please print 3 copies S/1 F,00u- 00.59
F-. FireSprinkler ,Fire Alarm Fire Misc
1. Project Addresa (Not mailing address) Floor
471 0-470 ft
.. ............ .... ........
Tenant Name (if Applicable)
2. Description of Work -SfjLjAjCGWl 0'Q#4j4-0AjrJtar 4jlir14
W_L-r-VW0_?& XEX�C
If Sprinkler How Many Heads?F77 -ZQ OW41ce—%
Check Appropriate Box for Applicant/Notification Information
# of Units (if Residential)
Suite No
F777
F_
Use 4MCe.%JeAj
I ................ - n,
Valuation $ [��
# Stories 57
FirUevc�st Lic. No.
4. Arch itect/Designer's Name Last
Architect/Designees Address Architect/Designer's E-mail Address
......................... ............ ....... ..... .... ... .. ..... ... ......... .. .... ...... ................................. .........
ZIP [77777 Telephone177777
City F_ State
1- ...
[—.6. Contractor's Name Last First Lic. No. .... ... ... ... ....... F4� �ii�9 'Class
Contractor's Address Contractor's E-mail Address
.............. %j3 q S GOV4SWIPA S - Ots106.
... .................. ... .. I ... .............
City State CA Zip Telephone
OFFICE USE ONLY 2P�4_*4" PERMIT NO. IZ &-f-L 7
� " '3 b 7)1 6 PLAN CHECK NO. 192.5-6 zvl�__
Rev 1118107 Associated Building Permit # . .... .. ... i .... ............. PLAN CHECK FEE $
Please print 3 copies
Worksheet for Fire Perrnit Application
City of Newport Beach - Building Department
[71 Fire Sprinkler -'f Flre Alarm r, Fire Misc
F
I.-Projdct Address (Nmailing address)
,ot
Floor
Suite No
OLD PjT�-VAPC3
..................... ... !�
State
T777
....... .. ... ...... .... ....... ..... . ....................
Tenant Name (if Applicable)
# of Units (if Residential)
F
OA_
2, Description of Work 5 V a. P,414C C,re. -,-%z m I -L c�ag. ;-4 ( e 4,y I Lk
Use i;->,
Ill .......... — ....... ......................
...........
If Sprinkler How Many Heads?
F7
Valuation $
TZ C19
FF
. .. ......
........... ........................... ... .............. ..... .............. ....... ....... ..... ......
# Stories
Check Appropriate Box for Applicant/Notification Information
3. Owner's Name Last
First
............... ............. ......................... F77777
J.7. 5. Engineer's Name Last First
Lic. No.
Engineer's Address Engineers E-mail Address
............. ............................................................................................ ..........................
....... ........................... ......................... .............................. .................................... ... ...........
City State Zip [7777777 Telephone[
. .. ..... ...
F-6. Contractor's Name Last First-
Lic. No.
Class
Contractor's Address
Contractor's E-mail Address
tJQ L �t o sr
State
Zip
... ........
............................ �.S owl ............
Telephone[
City
OA_
OFFICE USE ONLY
6
Rev 1118107 Associated Building Permit # FT7v1q-T
a:if �kjk 9
PLAN CHECK NO.
PLAN CHECK FEE $