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Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
1. Project Address (Not mailing address)
Tenant Name
2. Description of Work
Sprinkler rl Fire Alarm Fire Misc
Extg Sq Ft —i New/Added Sq Ft Total Sq Ft
ew ri Add [I Alter rl Demo
_..__... •rr• ter• • `.-w we �ijpucanurvotiricavon
Floor Suite No
-1
#units ��
Use
Valuation
$
# Stories L
F_ 3. Owner's Name Last
First �—
Owner's Address
_ - - ---- -- - - - -_ _.. - -- --�
Owner's E-mail Address
City
-I
State �i Zip F— Telephoned—
r- 4. Architect/Designer's Name
Last First Lic. No. F -
Architect/Designer's Address
Architect/Designer's E-mail Address
City
_ State Zip F_� Telephone—
r 5. Engineer's Name Last
First'
- j Lic. No.
Engineer's Address
Engineer's E-mail Address
City
I State F—I Zip I i Telephoned—
r 6. Contractor's Name Lastz First
p-iE�I . NsCass
Contractor's Address
C intractors :Fzma:ilder
e
City V.,-�_y. t e-� - __---_
- State EQS zip c7-p3\ Telephone
- - -_-_1710�C7
OFFICE USE ONLY �d z� . �, "'
Qj •0 `� I PERMIT NO. r (,,u{ h , 01QZj
TYPE OF CONSTRUCTION
c17n { , J V I� PLAN CHECK NO. ���L-Q {
YJ v/
OCCUPANCY- GROUP
PLAN CHECK FEE $