HomeMy WebLinkAboutF2017-0221 - Permit ApplicationWorksheet for Fire Permit Application
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City of Newport Beach - Building Division
Please print 3 copies
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Associated Building Permit # Fire Sprinkler r Fire Alarm r! Fire Misc
1. Project Address (Not maiming address)
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Last First
Floor Suite
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City
�,, State Zip Telephoned
Tenant Name
Architect/Designer's Address
#Units
2. Description of Work
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Use
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EMg Sq Ft i New/Added Sq FtFq'1S�j
i Total Sq Ft
Valuation $
New F-Addr Alter F-Demo
# Stories I f/
Check Appropriate Box for Applicant/Notification
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F 3. Owner's Name
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Last First
Owner's Address
Owner's E-mail Address
City
�,, State Zip Telephoned
. Arch itect/Desig ner's Name LastF 1M��-Cl' it First Lic.No.�—'
Architect/Designer's Address
Architect/Designer's E-mail Address
City.- ..
State F...... Zip F_—_I Telephone S.
ri 5. Engineer's Name
Last FirstF Lic. No.
Engineer's Address
Engineer's E-mail Address
City
i. State ['. Zip F_ Telephoned
6. Contractor's Name Last Ac}-. Fj/� Y Q First— ---- Lic. No. i k glass cj jp
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Contractor's Address
Contractors E-mail Address
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City (� I -- State C& Zip FM� Telephonef "� 1,q - 0,�)v � { b
OFFICE USE ONLY
° PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
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PLAN CHECK FEE $ a-0
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