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Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Fire Sprinkler F_ Fire Alarm F_ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
25L)q NIff w - F - �-
Tenant Name ADZ-' f),-� # Units r
2. Description of Work
Use
(�5t'A,t,C. vcs�,-s Firr.�. 5p12tM*-�G-tz- sy�rt;-M, trltbF 5l 1��5
Valuation $ i3; Say
Extg Sq Ft F— New/Added Sq Ft S 114-1 Total Sq Ft 5 / I L l
New F_Add F- Alter r— Demo # Stories F
Check Appropriate Box for Applicant/Notification
r 3. Owner's Name
Last G praa�)lu
First
Owner's Address
Owner's E-mail Address
City
State F
Zip [— TelephoneF_
F 4. Architect/Designer's
Name Last First —) �Oj� Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F_
Zip Telephone F_
F_ 5. Engineer's Name
Last f
First Lic. No. �—
Engineer's Address
Engineer's E-mail Address
City I-_�
State F_
Zip F_ Telephoned
F— 6. Contractors Name
Last �p�� y� First �Z Lic. No. ,F55% Class C, - I(o
Contractor's Address
Contractor's E-mail Address
City
State FCA
Zip I Telephone
OFFICE USE ONLY
I ✓ PERMIT NO.
v(
\'
TYPE OF CONSTRUCTION V I
PLAN CHECK NO. F
OCCUPANCY- GROUP
h
r' j�� PLAN CHECK FEE $
I