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Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
FireSprinkler ❑ Fire Alarm Fire Misc
1. Project Address(Not mailing address) Floor Suite No
1 {�
Tenant Name # Units
2. Description of Work
SUPUse
I---�
Extg Sq Ft � New/Added Sq Ft �� Total Sq Ft
Valuation $ ] ZDo
r7 New r] Add [� Alter F] Demo e�d�
# Stories 171
Check Appropriate Box for Applicant/Notification
information
F— 3. Owner's Name Last - i'� �P_First F7-7
owner's Address Owner's E-mail Address
2_2-0 Sr�v�2en
--------
city C Telephone I���
4. Architect/Designer's Name Last I — 7:77First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address ��JJ
CitY — State C 7 Zip [77 Telephone i/1 �K�., i�✓�
FI 5. Engineer's Name Last First F77777 Lic. No. L
Engineer's Address Engineer's E-mail Address
City _ _ 7 State !-7 Zip L� Telephone
nOL6. Contractor's Name Last /- First Lic. No. v_ii ss
Contractor's Address �! Contractor's E-mail Address 1
City �.IoM��„ State e� Zip Telephone
OFFICE USE ONLY-1L���I PERMIT NO. ^d�
TYPE OF CONSTRUCTION�vl� PLAN CHECK NO. V�
OCCUPANCY -GROUP rJ�� V PLAN CHECK FEE $