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Associated Building Permit #
Worksheet for Fire Permit Application 2505-2018 ��`WPo"m
City of Newport Beach - Building Division E.2018,05790
op�.r
5J Fire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. Project A1ddress (Not mailing address) Floor Suite No
1\ _I I_r._'RF\1. .a77 1777
Tenant Name _ # Units F1
LLLL
2. Description of Work
City _
State �— Zip F_ _7 Telephone—
Use
Architect/Designer's Address
���J1ll
Architect/Designer's E-mail Address
I
Extg Sq Ft �J New/Added Sq Ft Total Sq Ft
Valuation $
— -
Add Alter Demo
[Z New ❑❑ 1 ��
# Stories
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name
Last a `� 1 7 First �—
Owner's Address
Owner's E-mail Address
City _
State �— Zip F_ _7 Telephone—
❑ 4. Architect/Designer's Name Last First�— Lic. No. L— J
IIII�����
Architect/Designer's Address
���J1ll
Architect/Designer's E-mail Address
City �—
State 1 Zip [7777TelephoneF77:771
❑ 5. Engineer's Name
Last First F7:7777 Lic.No.�
Engineer's Address
Engineer's E-mail Address
--------- —
City
— — - ---
State Zip Telephone—
71
❑ 6. Contractor's Name Last LosFirstF�\� Lic. No. �'� (UJB Class L.(Q
Contractor's Address
Contractor's E-mail Address
City �`„`��, _ _ _ State Zip 'r4 in Telephone b.l (,,,r3 )D
OFFICE USE ONLY
r�'JSi f PERMIT NO.
TYPE OF CONSTRUCTION
OCCUPANCY -GROUP
W)
`) . � PLAN CHECK NO. -2 `` 2n(
V 2� PLAN CHECK FEE $