HomeMy WebLinkAboutF2017-0643 - Permit Application26�sL•20)i
Worksheet for Fire Permit Application 52017-06/43 �`'�`°"r�
City of Newport Beach - Building Division o
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Associated Building Permit # Fire Sprinkler j— Fire Alarm j` Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name I Units F
2. Description of Work
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I State F_- Zip F— Telephoned
. ArchitecUDesigner's Name Last First F_ Lic. No. F_
Architect/Designer's Address
1 .. Total Sq Ft
Extg Sq Ft New/Added Sq Ft2r F
Valuation $ IUD
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State ��. Zip F_ Telephone`—
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# Stories 1
ew r Add
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Engineer's Address
Check Appropriate Box for Applicant/Notification
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F 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City � -
I State F_- Zip F— Telephoned
. ArchitecUDesigner's Name Last First F_ Lic. No. F_
Architect/Designer's Address
Architect/Designees E-mail Address
City -
State ��. Zip F_ Telephone`—
F_ 5. Engineer's Name Last
First l-_ Lic No. C'
Engineer's Address
- Engineer's E-mail Address
City
State �. Zip Telephone
X6_ Contractor's Name Last L}— �)/_F�YT First Lic. No. R _lass C1
Contractors
Contractor's Address 4
E-mail Address
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City -_ 111/Vl1.l.�i�YV--, --
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State 16 Zip "lO..( 3, Telephone �/qtk/ bo—mt &
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OFFICE USE ONLY
PERMIT NO./ I -7' Ga
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TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
+z,57 P CHE FEE $
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