HomeMy WebLinkAboutF2017-0384 - Permit ApplicationTM to 012 F2 G
� Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # Fire Sprinkler r Fire Alarm r7 Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Last 1A'LG rcLl __
First--',
Tenant Name # Units
2. Description of Work
Use
Owner's E-mail Address
City
---
Extg Sq Ft New/Added Sq Ft Total Sq Ft j
Valuation $ F& '
New F- Add r Alter r— Demo a �� S
# Stories
Check Appropriate Box for Applicant/Notification
InfnrMn+;nn
F7 3. Owner's Name
Last 1A'LG rcLl __
First--',
Owner's Address
Owner's E-mail Address
City
State.I
Zip—__ Telephone
W
4. Architect/Designer's
Name Last�—
First
Lic. No. F `—
Architect/Designer's Address
Architect/Designer's E-mail Address
City I——
State F--:
Zip r TelephoneF
F 5. Engineer's Name
Last (--
First F --'
Lic. No.
Engineer's Address
Engineer's E-mail Address
City-
State
Zip �— Telephoned
..
[76. Contractor's Name
Last1L,_,, First m: Lic No. ��76UU4 Class (-�(
Contractors Address
Contractor's E-mail Address
iADA
City L�...:���.t
State C4
ZipF)jG. I i Telephone[`"_ijri
5..17:�
OFFICE USE ONLY
PERMIT NO.
VU 1 • D
TYPE OF CONSTRUCTION
PLAN CHECK NO.
114. °O 107
OCCUPANCY - GROUP
PLAN CHECK FEE $