HomeMy WebLinkAboutF2018-0342 - Permit ApplicationPrint Form;
Please print 3 copies
Associated Building Permit #
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Worksheet for Fire Permit Application of'�Re
City of Newport Beach - Building Division
❑ Fire Sprinkler Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address)
First
Floor Suite No
0
l k50 TA�Q
12607D
Zip � Telephoned
❑. 4. Architect/Designer's Name Last
Tenant Name i C9 C �N
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# Units
2. Description of Work
Zip F__71 Telephoned
❑ 5. Engineer's Name Last
Use
Engineer's Address
Engineer's E-mail Address
City State
Zip Telephoned
i/�6. Contractor's Name Last First �Lic. No. °7i(�7�6 Class C-/ (-)
Contractor's Address / AccTU g0A—K 'VL -V l'"_�5'dontractor's E-mail Address
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ValuationObb—
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Extg Sq Ft New/Added Sq Ft 2'Z Z To Total Sq Ft F22� Z.d
OFFICE USE ONLY
PERMIT NO.
d
TYPE OF CONSTRUCTION
# Stories F7
❑ New ❑Add ❑Alter
E] Demo
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City State �
Zip � Telephoned
❑. 4. Architect/Designer's Name Last
First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State
Zip F__71 Telephoned
❑ 5. Engineer's Name Last
First � Lic. No. r
Engineer's Address
Engineer's E-mail Address
City State
Zip Telephoned
i/�6. Contractor's Name Last First �Lic. No. °7i(�7�6 Class C-/ (-)
Contractor's Address / AccTU g0A—K 'VL -V l'"_�5'dontractor's E-mail Address
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I !ht
City H0i4N 7-cs ,/ State Fr/f-7Zip
�Telephone nTt � -L-5 j
OFFICE USE ONLY
PERMIT NO.
d
TYPE OF CONSTRUCTION
PLAN CHECK NO. ✓ v
OCCUPANCY- GROUP
PLAN CHECK FEE $