HomeMy WebLinkAboutF2018-0038 - Permit ApplicationWorksheet for Fire Permit Application
Please print 3 copies
City of Newport Beach - Building Division
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Associated Building Perm mire Sprinkler Fire Alarm
p r Fire Misc
1. Project Address (Not mailing address)
Floor
Suite No
3 q 9 3ZQ LLQ R\)e_ _
----
Tenant Name
# Units
pec esigner's
2. Description of Work
Firsts Lic. No.l
I
Architect/Designer's Address
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Extg Sq Ft F—' New/Added Sq Ft � Total Sq Ft �—'
Valuation $
2 (000
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F_ New r Add F_ Alter Demo
# Stories Z
Engineer's E-mail Address
Check Appropriate Box for Applicant/Notification
3. Owner's Name
Owner's Address
Last'
AN(7EZSSDN .
First
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----
Owner's E-mail Address
City fU2.wPo>«'t SEatr..! StateZiP
6A
aZCd� \.-_ Telephone
pec esigner's
me Last O
Firsts Lic. No.l
I
Architect/Designer's Address
ArchitectlDe gn s E-mail Address
City
State ( -..
Zip-- Telephone-------
5. Engineer's Name
Last
....._.._ ____
First Lic No.
Engineer's Address
Engineer's E-mail Address
city �
State �—
r -
Zip [_' Telephone)
F 6. Contractor's Name
Last FT. 7,4 L -r T
First g� —, Lic. No. � y�,l3O Class
Contractor's Address
Contractor's E-mail Address
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City �IAiJ Clirnvea`+.tE
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Zip Telephoneg4q Ia"1fS-yUos
OFFICE USE ONLY
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0 � O � PERMIT NO.I',
TYPE OF CONSTRUCTION
PLAN CHECK NO. � `- /-'-5
WI
OCCUPANCY - GROUP
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�4 S� PLAN CHECK FEE $
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