HomeMy WebLinkAboutF2018-0586 - Permit Application?6WPpRr
Worksheet for Fire Permit Application o4
Print Form< City of Newport Beach - Building Division
Please print 3 copies
_. A Q..aa,.,., D.,. it sre Sprinkler ❑ Fire Alarm Fire Misc
Floor Suite No
1. Project Address (Not mailing address) F1
r--
# Units
Tenant Name
2. Description of Work
Use
Valuation $ ?)SVC
Extg Sq Ft F New/Added Sq Ft �— Total Sq Ft
# Stories
New F] Add r7 Alter F]Demo
Check Appropriate Box for ApplicanvivouTICa><wn
3. Owner's Name Last
Owner's Address
�—
Owner's E-mail Address
TelephoneF777-71
4. ArchitectlDesigner's Name Last �—
First Lic. No.
Architect/Designees Address
City ----� State F
Architect/Designer's E-mail Address
Zip Telephone[
[7 5. Engineer's Name Last First Lic. No.
Engineer's Address
City State
6. Contractor's Name Last
Contractor's Address
City State
�cy
OFFICE USE ONLY
TYPE OF CONSTRUCTION
OCCUPANCY- GROUP
Engineer's E-mail Address
Zip � Telephone[
First [---_--_Lic. No. 67"llou� Class E-\�o
Contractor's E-mail A s
Zip "�t�4 b` Telephone --I-, 1C,
PERMIT NO.
'(� � PLAN CHECK NO. 6
V &rl L" PLAN CHECK FEE $