HomeMy WebLinkAboutF2017-0590 - Permit ApplicationWorksheet for Fire Permit Application Please print 3 copies G���ow�'' of'°R m
City of Newport Beach - Building Division � ` r
Associated Building Permit # r Fire Sprinkler Fire Alarm Fire Misc
1. Project Address (Not mailing address)
Tenant Name
2. Description of Work
Extg Sq Ft F New/Added Sq Ft F Total Sq Ft
;' New r Add i— Alter F_ Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
# Units
Use
Valuation$ t��,nb
# Stories
3. Owner's Name Last
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First i fz..
Owner's Address
Owner's E-mail Address
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City.. ��
State FZ74&.....
Zip cl'pcosc, Telephone: 6,,,—_"3'1(a—
I— 4. Architect/Designer's Name
Last
First Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City
tate
Zip F— Telephoned
r 5. Engineer's Name Last
First Lic No.;
Engineers Address
Engineer's E-mail Address
City
State IF—
Zip F Telephoned
F 6. Contractor's Name Last
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First i Lic. No. Class)
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Contractor's Address
Contractors E-mail Address
(3I-Lo TC-AL,J iD
5 7
City 1rlr`IUS-ill
State
Zip II G tt c{ Telephone; /�-�„�, _ ciLS -red <=�=
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. 1411 j�
OCCUPANCY - GROUP
PLAN CHECK FEE $