HomeMy WebLinkAboutF2018-0435 - Permit ApplicationWorksheet for Fire Permit Application4�EW�Rm
Print Form City of Newport Beach - Building Division
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Please print 3 copies G<opN
Associated Building Permit # A Fire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing addreesss\),� Floor Suite No
Tenant Name�./�. , "( # Units
I
2. Description of Work
Owner's Address
Owner's E-mail Address
Use
City -1
Valuation $
# Stories
Extg Sq Ft �— New/Added Sq Ft �— Total Sq Ft C
"Vew ❑ Add ❑ Alter ❑ Demo
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last
it rU, - LLC--1First C�
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Owner's Address
Owner's E-mail Address
City -1
State F___7
Zip C Telephone
❑ 4. Architect/Designer's Name
Last
First F777-71 Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City _ _
State
Zip [7:7-7 Telephone
❑ 5. Engineer's Name Last
_
First Ms Lic. No.
Engineer's Address
Engineers E-mail Address
City c
State
,��
Zip } 7 Telephone
❑ 6. Contractor's Name Last
First � Lic. No. F— Class
Contractor's Address
Contractor's E-mail Address
City
State I�
Zip F ------- Telephoned{
OFFICE USE ONLY
PERMIT NO. 1 I D ULM-
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $