HomeMy WebLinkAboutF2018-0147 - Permit Applicationt
Worksheet for Fire Permit Application to 1,(, Diy7
o City of Newport Beach - Building Division a
Please print 3 copies
Associated Building Fermi ��('6._�®�� FF/ ire Sprinkler Ft Fire Alarm [- Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name (�pjy�7 /%/t�J /j �, �e # Units j
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2. Description of Work
Use
City _..
State F Zip 7 Telephone�--
F_ JBrfle
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Extg Sq Ft New/Added Sq Ft Total Sq Ft
$
Valuat;t(M
_
# Stories F
New F_Add F_Alter r` Demo
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Check Appropriate Box for Applicant/Notification .� I/l, _ I5
F_ 3. Owner's Name Last
First ,
Owner's Address
Owner's E-mail Address
City _..
State F Zip 7 Telephone�--
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Last r�a j noy First � glc, /i Lic. No. F
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110o j r
_
Ar itecUDes,gnL W e'ss '
Architect/Designer's E-mail Address
F(6711:57- Vc W_(CaY 'Kurt s�t2�_C�J�. _
City
Telephone q--06
State �— Zip [77777 UV
{ 5. Engineer's Name Last
Y Fi stLic.'Nno.
- C ,
Ennggiinneeer's Address
Engineer's E-mail Address ISLP
City V ✓r ..-
State _-_ Zip FT �o,6 Telephone q #7(gq?,/®
l -L
F_ 6. Contractor's Name Last -. First F Lic. No. F Class
Contractor's Address
Contractor's E-mail Address
City
i _
State j-- Zip F_ Telephoned
OFFICE USE ONLY
0 PERMIT NO. UI
H
TYPE OF CONSTRUCTION
OCCUPANCY-
40
NCHE KN
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vU/ `� `'v y
GROUP
PLAN CHECK FEE $
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