HomeMy WebLinkAboutF2018-0562 - Permit ApplicationPrint Form
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Associated Building Permit #
X1ZIU
.11
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
FireSprinkler FFire Alarm
,2kI N x-,0180 �¢ nOq
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❑ Fire Misc
1. Project Address (Not mailing address) Floor�iSuite No
_0 L_6 ark ur_.Av ___ — _ F-7—
Tenant Name _-.--_ _ # Units F
2. Description of Work
City
State �� Zip Telephoned
Use
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I
Extg Sq Ft �1
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Valuation$��
New/Added Sq Ft E_ Total Sq Ft
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New [� Add r Alter ❑ Demo
# Stories
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last First
Owner's Address
Owner's E-mail Address
City
State �� Zip Telephoned
4. Architect/Designer's Name Last
�— First Lic. No.
Architect/Designer's Address
Arcl itect/Designer's E-mail Address
f
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City of I'a�
State ljLL J Zip 17 z_o Telephone T IV -0l V/
F 5. Engineer's Name Last
First F-7-71 Lic. No.
Engineer's Address
Engineer's E-mail Address
City I
State F-71 Zip F� Telephonel
F-16. Contractor's Name Last r kFirst �� Lic. No. M Class
Contractor's Address
Contractor's E-mail Address
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City0l �2 ��
StateZip 9VZ - Telephone Q -44 Y
OFFICE USE ONLY
TYPE OF CONSTRUCTION
PERMIT NO.ZE�y�j/� ,-
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PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $