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Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
-- n Fire Sprinkler F-1 Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Suite No
r—Floor
Tenant Name ((.ty\1y Lyryy„ ,��.5. .............� #Units
2. Description of Work
i
Owner's E-mail Address
Use (`
n /
Ext S Ft o t 1 2 (o New/Added S Ft[? -6
9 4 4 C).t._j Z [a_ Total S4 Ft l I �L--('J,.
Valuation $ 60 C'
J I Z
F_ New F_ Add r— Alter F7 Demo
# Stories FT
Check Appropriate Box for Applicant/Notification
3. Owner's Name
Last
First F
Owner's Address
i
Owner's E-mail Address
City—
State I
Zip Telephonee�
4. Arch itecUDesigner's Name Last
First Lic. No. F—
Architect/Designer's Address
Architect/Designer's E-mail Address
City.- --_--
---.. State-
Zip F__ -_-,.--i Telephone
r 5. Engineer's Name
Last _.
First —'. Lic. No. F
Engineer's
Engineer's E-mail Address
City
State
Zip—, Telephone F�
F_ 6. Contractor's Name Last
A F� U t a First ��� Lic. No. G 3� f Class C J (�
J
Contractor's Address
Contractor's E-mail Address
City X 1 ,> fi A C _
State t iol,
Zip §z 6 l /�' Telephone_ � �
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $