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Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Applicatipri
City of Newport Beach - Building)a6 H.b�* Ki
Fire Sprinkler F Fire Alarm Fire Misc
1. Project Address (Not mailing address) Floor Suite No
F)
# Units
Tenant Name
2. Description of Work
Use
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City
Valuation $ 000
New/Added Sq Ft Total Sq Ft
Extg Sq Ft F777 F
4. Architect/Designer's Name
# Stories
F7 New F_ Add F_ Alter F,_ Demo
Architect/Designees Address
Check Appropriate Box for Applicant/Notification
F— 3. Owner's Name Last
First
Owners Address
Owners E-mail Address
City
State F_ Zip
F Telephone[
4. Architect/Designer's Name
Last I Vd First i9dCl- Lic. No.
Architect/Designees Address
ArchitectfDesignaes E-mail Address
152.6-W-ShAyAle Avg_.YO
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City C ov 1�11 6
State Fc—A Zip Fql7f _f! TelephoneF_
F_ 5. Engineer's Name Lasti,
First F Lic. No.
F
Engineers Address
Engineers E-mail Address
City
State [7777 ZippF---
TelephoneF_
F` 6. Contractor's Name Last6
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First [77"7777 Lic. No. Class W
Contractor's Address
Contractor's E-mail Address
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City FJ_oX 661tk
State 04 zip
�0?p TelelphoneOto 319.141 M
OFFICE USE ONLY
PERMIT NO. CC,
-01
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $