HomeMy WebLinkAboutF2018-0658 - Permit ApplicationWorksheet for Fire Permit Application .98-71 _X/S��r��
City of Newport Beach - Building Division F ZO1:9-06Sg a ':
Please print 3 copies
Associated Building Permit# -1 W, Fire Sprinkler Fire Alarm Fire Misc
1. Project Address (Not /mailing address) Floor Suite No
First
Tenant Name #Units F
2. Description of Work
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Use
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Valuation $ I
Extg Sq Ft New/Added Sq Ft F Total Sq Ft F
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Architect/Designer's E-mail Address
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Check Appropriate Box for Applicant/Notification
F 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City _
State Zip I Telephone
4. Architect/Designer's Name LastI y p First DA Lic. No.
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
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F7j 5. Engineer's Name Last
First F Lic. No
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Engineer's Address
Engineer's E-mail Address
City
State Zip Telephone
r_ 6. Contractor's Name Last �iX,E7,) 1i' - S r�C1'�N First Lic No. �%2Z Class
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Contractor's Address
_ Contractor's E-mail Address
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OFFICE USE ONLY
x PERMIT NO.
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TYPE OF CONSTRUCTION
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OCCUPANCY - GROUP
4pL�kN CHECK FEE $
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