HomeMy WebLinkAboutF2018-0603 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3, copies
Associated Building Permit# Fire Sprinkler J_ Fire Alarm 7 Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name �4. � 'Y� V�: #Units
2. Description of Work
Use b.
State F_ Zip F— Telephonel
F 4. Arch itecUDesigner's Name Last
First Lic. No. `
EMg Sq Ft (i`6S New/Added Sq Ft Total Sq Ft � ��
Valuation $ )nt?co
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City I
7
# Stories
V
j— New P( Add ; Alter j— Demo
First l Lic. No.I
i
Check Appropriate Box for Appiicant/Notification
(— 3. Owner's Name Last
First;
Owner's Address
Owners E-mail Address
City �
State F_ Zip F— Telephonel
F 4. Arch itecUDesigner's Name Last
First Lic. No. `
Architect/Designer's Address
Arch itect/Designer's E-mail Address
City I
I
State I Zip Telephone'!
5. Engineer's Name Last i
First l Lic. No.I
i
Engineer's Address
Engineer's E-mail Address
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city
State State Zip F_ Telephoned
�6. Contractor's Name Lasti First' �� Lic. No. El I 1 1�1 classIM UK
1
Contractor's Address
Contractor's E-mail Address
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City ;.
State �G� Zip F T)�(}t Telephone,)l(�`�Zpl_'�
11
OFFICE USE ONLY
�(� C�,V PERMIT NO. �Y �/�\ OL4
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TYPE OF CONSTRUCTION
O
ry
OCCUPANCYGROUP
1'9� U PLAN CHECK FEE $
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