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Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
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ZZ 1 5APP41i2c
Tenant Name
2. Description of Work
X Fire Sprinkler r Fire Alarm r- Fire Misc
Extg Sq Ft F—
New/Added Sq Ft F—
Total Sq Ft 2/3
New F Add r Auer
r Demo
Check Appropriate Box for Applicant/Notification
f 3. Owner's Name Last
Owner's Address
First
Owners E-mail Address
Floor
Suite No
# Units
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Use
Valuation$
# Stories I J
City !
State �_ Zip
TelephoneF�
f 4. Architect/Designer's Name Last
FAA I tt6)ELC� First— Lic. No.
Arch itect/Designers Address
Architect/Designer's E-mail Address
city (�
State �_ Zip I TelephoneF�
I- 5, Engineer's Name Last
First—
--
Engineer'sAddress Lic. No. �—
Engineer's E-mail Address
City
Stale [' Zip F' TelephoneF —
P(6. Contractor's Name Last
Jt E a First F�— Lic. No. -ii�s w class
Contractor's Address / (= I �-
�{.. Contractor's E-mail Address
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City FAZ�HoL�' /aI,LSfAK �i E7M1MIL. (�.,{�
F:;�r State F a�- Zip
g2lo3d TelephoneF�bl-(.4m _
OFFICE USE ONLY
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TYPE OF CONSTRUCTION X 20 i;4 _v 77q
OCCUPANCY- GROUP
PERMIT NO. Flo ZZ-- d r Z
PLAN CHECK NO. C%Gy3-ZaZZ
PLAN CHECK FEE $ 2 2— z— ' aC_