HomeMy WebLinkAboutF2018-0557 - Permit ApplicationWorksheet for Fire Permit Application °s�0
Print Form' ;, i.I V&' City of Newport Beach - Building Division tPlease print 3 copies i�v°
Associated Building Permit # ❑ Fire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
_ First
Tenant Name ��- �Y�\S1 # Units L
2. Description of Work
Owner's E-mail Address
Use
State F-1 Zip Telephoned
❑ 4. Architect/Designer's Name Last
First r Lic. No.
Valuation $
I I
Extg Sq Ft F77_7 New/Added Sq Ft J Total Sq Ft
City
# Stories
�ew F] Add ❑Alter ❑Demo
❑ 5. Engineer's Name Last First 1777777 Lic. No.
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last _
_ First
Owner's Address
Owner's E-mail Address
City --_.. -
State F-1 Zip Telephoned
❑ 4. Architect/Designer's Name Last
First r Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State Zip F7_1 Telephoned
❑ 5. Engineer's Name Last First 1777777 Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State Zip Telephoned
❑ 6. Contractor's Name Last
First No. �i"l�e s�: Class :7�
Contractor's Address
�SLic.
Contractor's E-mail Addr
City 1---e,-��`or�
State ZipT1_0 Telephone ��__,�,
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
X-A
PLAN CHECK NO.OCCUPANCY
- GROUP
Inl ' PLAN CHECK FEE $