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Associated Building Permit #
Worksheet for Fire Permit Application 1065400
City of Newport Beach - Building Division �2(jfq-oz7y r
Y( ZOILi - I Z 1 1 I-`- Fire Sprinkler [_ Fire Alarm [ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
A
W
Tenant Name Q� WN t �O y�jr # Units pv —
2. Description of Work
Use
City / Ii) JAI k State G _ Zip [-?-Z �a/ T Telephone[�'
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F_ 4. Archite esigner's `ame Last I IS 1 + 11 First M t l< iz. Lic. No.
57 7(0'2 l
Valuation $ / 8r C90
Extg Sq Ft F_New/Added Sq Ft ��', Total Sq Ft ��,
9 075 w" LAA-77� zxz:r 92® MSL) iI t-vA),jCo o'
City .�j� � State//� Zip j �Z S Z"I Telephone "T/ 4 qtq 1 Q627
C
# Stories I
F" New r Add r Alter r, Demo
- -- —
Check Appropriate Box for Applicant/Notification
1- 3. Owner's Name Last �S G �ASA�_ j t LG First
Owner's Address Owner's E-mail Address
City / Ii) JAI k State G _ Zip [-?-Z �a/ T Telephone[�'
F_ 4. Archite esigner's `ame Last I IS 1 + 11 First M t l< iz. Lic. No.
57 7(0'2 l
Architect/Designer's Address Architect/Designer's E-mail Address -
9 075 w" LAA-77� zxz:r 92® MSL) iI t-vA),jCo o'
City .�j� � State//� Zip j �Z S Z"I Telephone "T/ 4 qtq 1 Q627
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F_ 5. Engineer's Name Last �- -- First �— Lic. No.
- -- —
Engineer's Address Engineer's E-mail Address
City F� State F_ Zip ��, Telephone
F- 6. Contractor's Name Last (ASLO �-,z)r_TRoTRcTiwv First F Lic. No. 5776v ClassFG ,
Contractor's Address Contractor's E-mail Address
City A ', State Q Zip cT-ld" 77.i Telephone 7/0 TRY 1'660
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OFFICE USE ONLY PERMIT NO.
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TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY - GROUP q�' 2 , �U6 PLAN CHECK FEE $
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