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Print Form Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # �— ]R Fire Sprinkler n Fire Alarm r'; Fire Misc
1. Project Address (Not mailing address) Suite No
rFloor
2312 Lctur'?,-1 Places_ _ I 2
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Tenant Name _ . ®use A, �3 I±J _ # Units I
1
2-.. Description of Work
Use
C
L1�S LtI nf:fR) 7F' 'Ioefes' Sy$'6' � (z
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3' 'ire=_Seri
ArchitecU A ass
�I—) G%ciji—L;C) r�j> herr�S
City _. _
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Extg Sq Ft F New/Added Sq Ft Total Sq Ft 13550
Valuation $ F-35 ob
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Last � First F—, Lic. No.
# Stories
Fo
r; New JZAdd r, Alter r, Demo
City �— State��, Zip Telephone
Check Appropriate Box for Applicant/Notification
r', 3. Owner's Name
Last First';"��
Owner's Address
Owner's E-mail Address (Jc/
City
__. State F' Zip F TelephoneF
r, . rc t c Designer's Name L t First Lic No.
ArchitecU A ass
Architect/Designer's E-mail Address
City _. _
State F Zip F TelephoneF
n 5. Engineer's Name
Last � First F—, Lic. No.
Engineer's Address
Engineer's E-mail Address
City �— State��, Zip Telephone
6. Contractor's Name
Last r l d� ► G Ue-Z First C }O r t S Lic. No. Roil �s ClassF&
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C/o�n��trractor's Address
Contractor's E-mail Address
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e !v e� � I Fl1-es(jTLLr✓e
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City
L(f POt'»C��
State /� �J'7 )
Telephone7 � t' a, Quo 7 � G
zip cel Z7 7_
1. �'
OFFICE USE ONLY
PERMIT NO. V
�P2NO, 0239 �
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TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $
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