HomeMy WebLinkAboutF2021-0307 - Permit Applicationf�'-7102.1 - 030 7 360 SiM M i ( .1V
Worksheet for Fire Permit A plication
Print Form City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # P2021.0369 / X2021.0793 j- Fire Sprinkler (X Fire Alarm F_ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
360 San Miguel F 360
Hoag Medical Group Internal Medicine T.I. # Units
Tenant Name
2. Description of Work
State F Zip F Telephone?
(—•. 4.-AfGh4eWDesigner's
Use
Fire Alarm Tenant Improvement 27 - Devices
Architect/Designer's E-mail Address
8724 Millergrove Dr.
Valuation $ 12000
Extg Sq Ft 4536 New/Added Sq Ft F Total Sq Ft
State CA Zip 90670 Telephone562-325-6426
-New -Add
# Stories F
F F (x Alter [_Demo
Engineer's E-mail Address
Check Appropriate Box for Applicant/Notification
F_ 3. Owners Name
Last First F
Owner's Address
Owner's E-mail Address
City
State F Zip F Telephone?
(—•. 4.-AfGh4eWDesigner's
Name Last Ferris - First Kelly Lic. No. 750781
Architect/Designer's Address
Architect/Designer's E-mail Address
8724 Millergrove Dr.
kellyf@weprotectall.com
City Santa Fe Springs
State CA Zip 90670 Telephone562-325-6426
F_ 5. Engineer's Name
Last First F Lic. No.
Engineers Address
Engineer's E-mail Address
City
State Zip Tel ephone—
.......
-- -t-
r 6. Contractor's Name
Last Ferris FirstKelly Lic No. 1 Class C-10
Contractor's Address
Contractor's E-mail Address
8724 Millergrove Dr.
kellyf@weprotectall.com
City Santa Fe Springs
State CA Zip 90670 Telephone 562-32n5--6426
OFFICE USE ONLYn
PERMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK NO. U 1
tV
J
OCCUPANCY - GROUP
PLAN CHECK FEE $
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