HomeMy WebLinkAboutF2018-0501 - Permit ApplicationT720N11-10 -oma i
Print Form
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
L(t® Fire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. Project Address (Not mailin dress) Floor Suite No
15_ �_ _ 0ceaia PVC1 - F77 -71
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Tenant Name # Units F
2. Description of Work
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City _ _ _
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Architect/Designer's Address
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Architect/Designer's E-mail Address
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Extg Sq Ft �J New/Added Sq Ft L�J� Total Sq Ft F
Valuation $ �00Q
New ❑Add ❑ Alter ❑ Demo
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Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name
Last First
Owner's Address
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Owner's E-mail Address 6
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City _ _ _
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State Zip F77777]r—tTeelepho�ne 7 __ I
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❑ 4. Architect/Designer's Name Last Cum First I i_,I, , Lic. No.l
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Architect/Designer's Address
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Architect/Designer's E-mail Address
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❑ 5. Engineer's Name
Last First Lic. No.l
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Engineer's Address
Engineer's E-mail Address
City
State Zip F7777 TelephoneE77_71
❑ 6. Contractor's Name Last t peru � S r �� �QrFirst F___— Lic. No.t l2 4 - Class
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Contractor's Address
Contractor's E-mail Address
City State ® Zip Telephone 0,-0
OFFICE USE ONLY
"7C�l `]� ��)��r �y PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY -GROUP
/�; PLAN CHECK FEE $