HomeMy WebLinkAboutF2018-0458 - Permit Applicationtg6'q_g1g
Print Form Worksheet for Fire Permit Applicationou
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # A 0_ Fire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. ProjectAddress (Not mailing address) Floor Suite No
^r y
Tenant Nameti Units
2. Description of Work
Zip Telephone
E
4. Architect/Designer's Name Last—�
_
Architect/Designer's Address
Use
City State F771
Zip Telephoned
Valuation $ ��
II—I
Extg Sq Ft New/Added Sq Ft L�J Total Sq Ft
ew ❑ Add ❑ Alter ❑ Demo
#Stories
Check Appropriate Box for Applicant/Notification
I..F...w...4'....
❑ 3. Owner's Name Last L— First
4
Owner's Address ��C
Owner's E-mail Address V ✓
City —� State �—
Zip Telephone
E
4. Architect/Designer's Name Last—�
First � Lic. No. 1_7
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F771
Zip Telephoned
❑ 5. Engineer's Name Last �- First Lic. No.
Engineer's Address
Engineer's E-mail Address
City State I
zip FCC]�7,1 Telephone'
❑ 6. Contractor's'Name Last
First r�Lic. No. l) lass FEE
`
Contractor's Address
Contractor's E-mail Address
b\ 77
CityState -�A
Zip Telephone
OFFICE USE ONLY ���� .�
y4
�� PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. '
OCCUPANCY- GROUP `
,.s PLAN CHECK FEE $