HomeMy WebLinkAboutF2016-0290 - Permit ApplicationIFZoi U - NA o
Print Form
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
r, Fire Sprinkler r'„ Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Owner's Address
#Units
Tenant Name
2. Description of Work
Use 75
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Extg Sci Ft —', New/Added Sq Ft ', Total Sci Ft
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1- 5. Engineer's Name Last
# Stories
New r Add r Alter r Demo
Engineer's E-mail Address
i
Check Appropriate Box for Applicant/Notification
r 3. Owner's Name Last First—
Owner's Address
Owner's E-mail Address
City
State Zip F— Telephoned
F' 4. ArchitectlDesigner's Name Last
t
�)�. /' FirstLic No.
/
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
City
State Zip �— Telephoned—,
1- 5. Engineer's Name Last
First F Lic. No. F
Engineer's Address
Engineer's E-mail Address
i
City
State �� Zip Telephoned
F,,,6. Contractor's Name LastLj) GAFirst /JOT -pe `fo;- Lic No. Class '
Oentractor's Address
Contractor's E-mail Address
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State Zip �2�'7%; Telephone C�Lfe(— q3_�'iL(��'
OFFICE USE ONLY
�oj��3I PERMIT NO.
TYPE OF CONSTRUCTION
(/ PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $