HomeMy WebLinkAboutF2018-0585 - Permit Application (2)Worksheet for Fire Permit Application
Print Form' City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # Fire Sprinkler ❑ Fire Alarm [ Fire Misc
1. Project Address (Not mailing address)
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Tenant Name
2. Description of Work
Floor Suite No,
# Units I71
F7
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Use I
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I '"-- - Valuation$
Extg Sq Ft. �J New/Added Sq Ft �- Total Sq Ft S �n i/�/y�^�►
# Stories V
j -J New F� Add [71 Alter L7 Demo
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last Z First w t' i
Owner's Address Owner's E-mail Address
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City --r{.Zw- /)C;, I- I State �(.'1- Zipt(LZGZ, Telephoned
�ect esignees Name First P Lic. No.
Architect/Designer's Architect/Designer's E -m ' ddress
City State F-71 Zip F7777Telephone
5. Engineer's Name Last First Lic. No.
Engineer's Address Engine ' E- ail Address
city _ State Zip Telephone
6. Contractor's Name Last74 y Z First �- y Lic. No. (;, y2 Class Cy 4
Contractor's Address Contractor's E-mail Address
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City Muj[ ))ZO41, i State LJi-i Zip yJo/L Telephone
OFFICE USE ONLY _D26 t D "` l t `t PERMIT NO. r�
TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY - GROUP PLAN CHECK FEE $