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Worksheet for Fire Permit Application
Print:Form City of Newport Beach - Building Division
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Associated Building Permit # �(Q ,���f Fire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address)
Floor Suite No
First �—
77
F-77
Tenant Name
City �— -- 1
# Units
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2. Description of Work
❑ 4. Architect/Designer's Name Last7_0�
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Architect/Designer's E-mail Address
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State �� Zip
Extg Sq Ft F_
New/Added Sq Ft F77777bs�0 Total Sq Ft
Valuation$
❑ New ❑Add
[7 Alter [7 Demo
# Stories
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last
First �—
Owner's Address
Owner's E-mail Address
City �— -- 1
State F— Zip
— TelephoneF__7
❑ 4. Architect/Designer's Name Last7_0�
First �. Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
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_-` 1,09 _
cityQ 1_Telephoner,/75
State �� Zip
e0_61
q17�'�' Telephon/ l
❑ 5. Engineer's Name Last _
—I
First F-7771 Lic. No.
Engineer's Address
Engineer's E-mail Address
City ��
State �— Zip
Telephoned
❑ 6. Contractor's Name Last �/ ger GQ� -First-777CLic. No. �� Class l b
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Contractor's Address
Contractor's E-mail Address
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State Zip
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OFFICE USE ONLY
PERMIT NO. C�� `O�S�
TYPE OF CONSTRUCTION
PLAN CHECK NO. i t 7 C�n1
OCCUPANCY - GROUP
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b, /u ( PLAN CHECK FEE $