HomeMy WebLinkAboutF2019-0590 - Permit ApplicationWorksheet for Fire Permit Applicatior 4 " m
Picot Form ', i City of Newport Beach - Building Division
Please print 3 copies 5lq ® oa •"
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Associated Building Permit# X2017-1891 (1288-2017) F, Fire S' mkler [7 Fire Alarm F Fire Misc
1. Project Address (Not mailing address) UI t e 'S Fl—oor- Suite No
441 Old Newport 12 200
Tenant Name Dr. Rowshawn # Units
2. Description of Work
Use Office
Owner's E-mail Address
Fire Sprinkler Tl - Add/relocate (29) sprinklers
- -- ----- - --- --
Zip I- ' TelephoneF77777
Valuation $ 3900
Extg Sq Ft 2524 New/Added Sq Ft 2524 ',, Total Sq Ft 2524
--
_- _.--
# Stories F7
F_ New r Add FTAlter I-, Demo
City
Check Appropriate Box for Applicant/Notification
Infnrmnti^n
3. Owner's Name
Last
First F—
Owner's Address
Owner's E-mail Address
City
State F_
Zip I- ' TelephoneF77777
F, 4. Arch itect/Designer's
Name Last
First Lic. No.
Architect/Designer's Address
Architect/Designees E-mail Address
City
State F
Zip l Telephone
rl 5. Engineer's Name
Last
-
i First F Lic. No.
-
Engineer's Address
Engineer's E-mail Address
City
StateF
Zip Telephoned
jx 6. Contractor's Name
Last JB Fire Protection, Inc FirstJoe Bledsoe Lic. No. 647282 Class C-16
Contractor's Address
Contractor's E-mail Address
1229 E. Ash Ave.
I
toe@jbfireprotection.com
City Fullerton
State CA
Zip 92831 Telephone 714-578-0900
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. �� I
OCCUPANCY - GROUP
PLAN CHECK FEE $