HomeMy WebLinkAboutF2018-0560 - Permit ApplicationWorksheet for Fire Permit Application *149
Print Form City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # Fire Sprinkler I —I Fire Alarm n Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name # Units
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2. Description of Work
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Valuation $ cu I
Extg Sq Ft New/Added Sq t j Total Sq Ft -70
1
New r'I Add r', Alter F—,Demo # Stories
Check Appropriate Box for Applicant/Notification
F_ 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City
i State F_7
Zip F--7 Telephone-1
`12rc esigner's Name
Last _ -
-_- _ First _ vV[ Lic. No.
III
Archi[ecUDesig ddres
Architect/Designer's E-mail Address
City
State
Zip— Telephone��
r 5. Engineer's Name Last
-
J First F I
-Lic. No.
Engineer's Address
tt Engineer's E-mail Address
City
�. State
zip F Telephoned
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6. Contractor's Name Last 60 i' First ' Lic. No. Class
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Contractor's Address
Contractor's E-mail Address
City 5 ,9--� j.}�..,�}
_ State FT�7
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Zip q _761� i Telephon %1l ,h-.--(r)''
OFFICE USE ONLY
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PERMIT NO. U J
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
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�C PLAN CHECK FEE $