HomeMy WebLinkAboutF2018-0647 - Permit ApplicationF7.0146 -0(2)L4-7
Worksheet for Fire Permit Application �`�'°"^
Print For City of Newport Beach - Building Division
Please print 3 copies ,;Fop„,>
Associated Building Permit # x� — I j, \LC Fire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address)
Floor Suite No
Owner's Address
Owner's E-mail Address
Tenant Name
, i
# Units
2. Description of Work
Last
Use
--
Valuation $ /DOQJ
<
Architect/Designer's Address
J l/
Architect/Designer's E-mail Address -1
I
Extg Sq Ft �J New/Added Sq Ft F _77 Total Sq Ft
State �—
New
❑Add ❑Alter ❑ Demo
First F Lic. No.
# Stories
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last`
L 7 First
Owner's Address
Owner's E-mail Address
City 7777
State F7777
Zip � Telephoner
r_14. Architect/Designer's Name
Last
I�
First Lic. No. f
Architect/Designer's Address
Architect/Designer's E-mail Address -1
City �—
State �—
Zip17777 TelephoneF77— I
❑ 5. Engineer's Name Last
First F Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State _
Zip �� Telephone��
❑6. Contractor's Name Last
4�L,
/
First[= -/---J Lic. No. Class
Contractor's Address
Contractor's E-mail Address
v
City
State [77&�
Zip _ d Rolfe ��
OFFICE USE ONLY
PERMIT NO. � U — d61t_ 7
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUPr
PLAN CHECK FEE $