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Worksheet for Fire Permit Application o�
City of Newport Beach - Building Division �?Ol q _05
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Associated Building Permit # F Fire Sprinkler F_Fire AlarmFire Misc
1. Project Address (Not mailing address)
Floor Suite No
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Owner'sE-mail Address
Tenant Name I#
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Units F
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2. Description of Work
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Use
Extg Sq Ft
New/Added Sq Ft Total Sq Ft
Valuation $
City
State F Zip
# Stories
New r—Add
F—AfterF—Demo
FirstF Lic.No. F
Check Appropriate Box for Applicant/Notification
(— 3. Owner's Name Last ///(yp p �I� \ ��
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Owner's Address
Owner'sE-mail Address
City �
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State T""Zip �Teleph
F_ 4. Architect/Designer's Name Last
, First F Lic. No. F
Architect/Designer's Address
Architect/Designers E-mail Address
City
State F Zip
F Telephone —
F_ 5. Engineer's Name Last
FirstF Lic.No. F
Engineer's Address
Engineer's E-mail Address
City _
State Zip
F Telephone
Contractor's Name Last
First ��> Lic No. S(I ss W
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Contractor's Address
Contractor's E-mkl Address
City 1 ,v !T
StateZip
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FO Teleph
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
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PLAN CHECK NO.
OCCUPANCY- GROUP
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PLAN CHECK FEE $
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