HomeMy WebLinkAboutF2018-0540 - Permit ApplicationPrint Form'
Please print 3 copies
Associated Building Permit #
,K4M -V1-94V
Worksheet for Fire Permit Application ?� '°"m
City of Newport Beach - Building Division
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Fk ire Sprinkler [ Fire Alarm Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name `/12140 2 &-St oe_NGL # Units F7
2. Description of Work
City _ _
State Zip [7-- Telephoned
511s� c_, _ Cao , ,
I First Lic. No.
Use
Architect/Designer's E-mail Address
City _
Valuation $ o , 0,
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Extg Sq Ft New/Added Sq Ft � Total Sq Ft
Engineer's E-mail Address
FVI�fVew F]Add D Alter r -]Demo
# Stories
Check Appropriate Box for Applicant/Notification
[ 3. Owner's Name Last!
First
Owner's Address
Owner's E-mail Address
City _ _
State Zip [7-- Telephoned
[ 4. Architect/Designer's Name Last
I First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City _
State F� Zip E� Telephone—
r 5. Engineer's Name Last & lc t Sf e,' First
�+///� Lic.No. F-71
Engineer's Address
Engineer's E-mail Address
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City (� e-4lu i
II State [Z Zip � � j Telephone[7711 _ 1 j3 .- ? �
[f 6. Contractor's Name Last KIE, � First 5 J Lic. No. g7blfp3 Class
Contractor's Address
Contractor's E-mail Address
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city'(i�1_
StateI_7 Zip U/'.�(o,Llf� Telephone lr(�cJO.T_7
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP�J
_hi ( PLAN CHECK FEE $