HomeMy WebLinkAboutF2018-0228 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division ;
Please print 3 copies F2,0 li(b U
Associated Building Permit# r Fire Sprinkler Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
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Floor Suite No
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City
State F_ Zip F__ Telephone)—
Tenant Name
Last First F Lic. No.
# Units F
2. Description of Work
City
'. State F_ Zip F_ Telephone—
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tDle NW waorts/CC t�^gPCayo
Use
To COvl4ocrrx Lu��h
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Valuation$li 5Ob
Extg Sq Ft New/Added Sq Ft �—
Total Sq Ft
-,
Contractor's E-mail Address
1153°
# Stories F
F7,New [` Add F_Alter (! Demo
State G7A Zip& 3I Te Iephone6 676Z)(oS0-2./69
OFFICE USE ONLY
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last
/t'%� �/) First
Owner's Address
Owner's E-mail Address
City
State F_ Zip F__ Telephone)—
r- 4. Architect/Designer's Name
Last First F Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
'. State F_ Zip F_ Telephone—
F- 5. Engineer's Name Last
First Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State F777, Zip F Telephoned--'
6. Contractor's Name Last First �jQ y L)9) Lic. No. �Yf6if/0 Class
Contractor's Address
Contractor's E-mail Address
1153°
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City I FV)(C r -4,)A.
State G7A Zip& 3I Te Iephone6 676Z)(oS0-2./69
OFFICE USE ONLY
PERMIT NO. W��7 — Z
/ _ -z-01r,
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
_ f� �7 / / PLAN CHECK FEE $
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