HomeMy WebLinkAboutF2018-0383 - Permit ApplicationT=ZU 100 - 03t)3
Worksheet for Fire Permit Application o?EWER
Print Form; City of Newport Beach - Building Division
Please print 3 copies �<�ppN��
Associated Building Permit # L�___77771 [Fire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address)
Floor Suite No
L«dam ZS/.e
Owner's E-mail Address
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Tenant Name
❑ 4. Architect/Designer's
# Units
2. Description of Work
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Use
Last First Lic. No.
Engineer's Address
Engineer's E-mail Address
Extg Sq Ft F77777New/Added
I
Sq Ft Total Sq Ft
Valuation3
New ❑Add
[7 Alter [7] Demo
#Stories
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name
Last ��VE`J First
Owner's Address
Owner's E-mail Address
City
State Zip Telephoner _
❑ 4. Architect/Designer's
Name Last C �s1NbC� FirstLic. No.
Architect/Designer's Address
Architect/Designer's�EAddress
y23
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�,�
City 1'>s'Y1�^— State Zip F77:71Telephoned
❑ 5. Engineer's Name
Last First Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State Zip C— Telephone
❑ 6. Contractor's Name
Last First Lic. No. (9T2,82aj Class
Contractor's Address
Contractor's E-mail Address
City
StateF771Zip � TelephoneF_
OFFICE USE ONLY
PERMIT NO. Od5
TYPE OF CONSTRUCTION — PLAN CHECK NO. 1'�i1iO•?,gl�
OCCUPANCY - GROUP
PLAN CHECK FEE $
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