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Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
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1. Project Address (Not mailing address) Floor Suite No
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Tenant Name �L-w._ i I i Tj J
'— 1 # Units I I
II
2. Description of Work
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Valuation $ .21 y5 d
❑ 4. Architect/Designer's Name Last—�
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Architect/Designer's Address
Extg Sq Ft . ^�jl C1 New/Added Sq Ft Total Sq Ft Fp (U 5 79
❑ New FAdd L7 Alter ❑Demo
# Stories
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last— First F
Owner's Address
Owner's E-mail Address
City
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State F-7 zip[ ----7 TelephoneF77—:77
❑ 4. Architect/Designer's Name Last—�
First �— Lic. No. F77
Architect/Designer's Address
Architect/Designer's E-mail Address
—77
City
State Zip Telephoned
❑ 5. Engineer's Name Last �—
First E77-71 Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State I Zip Telephoned
P�6. Contractor's Name Last (It. ' First �Lic. No. Class CIU �l
Contractor's Address
Contractor's E-mail Address
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State Zip Telephone
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. 41L -Q
OCCUPANCY- GROUP
--�oIf'n PLAN CHECK FEE $
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