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PrinfForm Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # j— Fire Sprinkler r Fire Alarm 7 Fire Misc
are
1. Project Address (Not mailing address) Floor Suite No
1850 Jamboree Road
# Units
Country
Tenant Name Big Canyon Club
2. Description of Work
Use S-1,6
City Newport Beach State
Relocation of Existing Fuel Tank Permit (Aboveground Storage Tank)
r 4. Architect/Designer's Name Last I
First Lic. No.
/
Valuation $
Extg Sq Ft F— New/Added Sq Ft F— Total Sq Ft F_
f
F_ Zip F— Telephoned
#Stories F
(— New r Add [X Alter F—Demo
Engineer's Address
Check Appropriate Box for Applicant/Notification
I..F........ 41 -
FX_ 3. Owner's Name Last Beardsley
First Jeff
Owner's Address
Owner's E-mail Address
1 Big Canyon Drive
jbeardsley@bigcanyoncc.org
City Newport Beach State
CA Zip 92660 Telephone—
r 4. Architect/Designer's Name Last I
First Lic. No.
Architect/Designer's Address
Architect/Designers E-mail Address
City I State
F_ Zip F— Telephoned
R 5. Engineer's Name Last IBRAHM
FirstFATIMA Lic. No. �—
Engineer's Address
Engineer's E-mail Address
1000 Wilshire Blvd, Suite 250
fibrahim@jensenhughes.com
City Los Angeles State
CA Zip 90017 Telephone 949.209.757799
r S. Contractor's Name Last �j � Q fp/! /1 t� Lic. No. �71y classFj%
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Contractor's Address4P6 —%b �� �/[�/
�! Contractor's Address
�E-mail
City f (�� r/�/� �C State—
U U V V j�J/'
Zip fpf,j�/ Telephone /�y (1 I%l yY7 e,fD
tT 6 17 J
OFFICE USE ONLY
PERMIT NO.
t
TYPE OF CONSTRUCTION
PLAN CHECK NO. bQ b
OCCUPANCY- GROUP
PLAN CHECK FEE $