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Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
—� L. Fire Sprinkler ❑ Fire Alarm
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Fire Misc
1. Address (Not mailing address) Floor Suite No
/P-rroject
Tenant Name # Units
2. Description of Work
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Use
Sq Ft �� New/Added Sq Ft Total Sq Ft
Valuation $
70�Extg
F7New E]Add (7 Alter � Demo
# Stories IL
L�
Check Appropriate Box for Applicant/Notification
F-1 3. Owner's Name Last C First �—
Owner's Address Owner's E-mail Address
City _ State F Zip � Telephone[
4. Arch itectlDesigner's Name Last First O Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City ei ��__l.�l State ��FI-J Zip I} 7�4' Telephone '7/
❑ 5. Engineer's Name Last First Lic. No.
1771
Engineer's Address Engineer's E-mail Address
City State Zip �J Telephone F7771
6. Contractor's Name Last Fist Lic No. Class
LF r
Contractor's Address Contractor's E-mail Address
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City I State FC Zip (D �'6 Telephone 7?�/
OFFICE USE ONLY ��� Zo n PERMIT NO. DZJ`i
TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY- GROUPi%1 V I �� PLAN CHECK FEE $