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Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
r Fire Sprinkler K Fire Alarm r Fire Misc
t. Project Address (Not mailing address) Floor Suite No
4. "7s -1 � Ti I F,
Tenant Name 9 #Units F
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7
2. Description of Work
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Use 1 G
Valuation $
Extg Sq Ft F New/Added Sq Ft � Total Sq Ft
# Stories I 1
I— New r Add r Alter F_ Demo
Check Appropriate Box for ApplicanVNotification
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r 3. Owner's Name Last 17Ml Zr ).,Ajrirst F_
II
Owner's Address
Owner's E-mail Address
City Nr-.� Q7v7`I ® State �
Zip Telephoned
F_ 4. Architect/Designer's Name Last
First �— Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F
Zip F Telephone—
r 5. Engineer's Name Last 'r���j�
First PC1<1 Lic. No. 1 qG
Engineers Address
Engineer's E-mail Address
v1 6, Z4�M�1
Ci State �
ty �� % I vim`
Zi Tele hone G
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r 6. Contractor's Name Last -P $r, IA7r-1v First Lic. Nof Class
Contractor's Address
Contractors E-mail Address
City State
Zip F Telephoned
OFFICE USE ONLY
PERMIT NO. F26210 390
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TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $