HomeMy WebLinkAboutF2018-0283 - Permit Application113 7-�0/9 Fgoi & og 93
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Fire Sprinkler
L 7- J Fire Alarm Fire Misc
ress (Not mailing address)
Name lc>,
2. Description of Work
Extg Sq Ft F7777 New/Added Sq Ft F7777 Total Sq Ft F77777
�I_ew [_ Add F_ Alter F— Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
F77 --__-
# Units F77
Use
Valuation $ M � i
# Stories F
f`3. Owner's Name Last
First
F
Owner's Address
Owners E-mail Address
City State F777 Zip
F----- TelephoneF____
_J
F 4. Architect/Designer's Name Last First Lic.
No.
Architect/Designers Address
Architect/Designer's E-mail Address
City State Zip
Telephone F
r— 5. Engineer's Name Last
First Lic.
No.
Engineer's Address
Engineers E-mail Address
City State F__ Zip
F TelephoneF�_
f— 6. Contractor's Name Last
First Lic. No.
1
:`m`a,,A
Class F
6 7 6 0
C�
Contractors Address
Contractor's d1;
State Zip
Telephone
ONLY PERMIT NO. T—WQ5 — 07-5,1S
RUCTION PLAN CHECK NO.
, OUP PLAN CHECK FEE $