HomeMy WebLinkAboutF2018-0645 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # _ )(Z•l`6.3��g _ �; Fire Sprinkler Fire Alarm i- Fire Misc
1. ProiOct Address (Not mailing add
Tenant Name
2. Description of Work
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Extg Sri Ft New/Added Sri Ft J Total Sq Ft
[j New ❑ Add [: Alter (] Demo
Check Appropriate Box for Applicant/Notification
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Floor
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Suite No
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# Units
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Valuation $ _
# Stories u
3. Owner's Name-
- Last irst��
Owners Address
Owner's E-mail Address
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City "y�L �N�/
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_ I State L C//,,� Zip �_Z Lr L� Telephone
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❑4. Architect/Designer's
Name Last _ FirstLic No.
Architect/Designees Address
Architect/Designees E-mail Address
City
J State Zip Telephoned)
5. Engineer's Name
Last First Llc. No.
Engineers Address
Engineer's E-mail Address
WAY
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_ J (State FL Zip / Telephone Gd - k� I k7/yQ
- 16. Contractor's Name
Last o C 1 tH� Lic No. C� Class
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Contractor's Address
Contractor's E-mail Address
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City _ -
—J State Zip Telephone
OFFICE USE ONLY
PERMIT NO. Na • 17445r
TYPE OF CONSTRUCTION PLAN CHECK NO. (�a� • ( b
OCCUPANCY - GROUP
PLAN CHECK FEE $
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