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Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Fao1) -0.34 )-
F_ Fire Sprinkler r Fire Alarm Fire Misc
1. Project Address (Not mailing address) Floor No
r�Suite
65 o 60 a:Fm g� rv� QIZI v- F
Tenant Name Vivoloe/ , nAl w UVII9 # Units
2. Description of Work
�I-� iK'.Gfi1�1YI Ct� Q�Vt-I-2►1 K Q S yS-IPj'Vl
Use
Valuation $ -70, drp
Extg Sq Ft� New/Added Sq Ft Total Sq Ft
# Stories
r` New j_ Add F_ Alter �Demo
Check Appropriate Box for Applicant/Notification
information
[_ 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City
State Zip F Telephones
4. Arch itect/Designer's Name
Last First �- Lic. No.
F
Architect/Designer's Address
Arch itect/Designer's E-mail Address
City
State Zip Telephone
F 5. Engineer's Name Last
First F Lic. No.
F
Engineer's Address Address
Engineer's E-mail Address
City
State Zip F_ Telephone
[X 6. Contractor's Name - Last WICAN First 6 Lic. No. ggg17�j Class Cf7�C
G- t0
Contractor's Address
Contractor's E-mail Address
z�466 t_c, Pu/ m o 4v-f/
SU rn I ca Y @ w2,q-ua,,5i-,r7 ve- w e. ccwl
City I�0(bq 61044
State t Zip I -' 7 Telephone 71`�_gs7 57;6)
OFFICE USE ONLY
PERMIT NO. g
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $