HomeMy WebLinkAboutF2021-0194 - Permit ApplicationWorksheet for Fire Permit Application�4
A,' PrtriEgrm City of Newport Beach - Building Division %%/) 7
Please print 3 copies Fz0z I ' U
Associated Building Permit # I X zOZ j - 068(o R Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address L(Not mailing address) Floor Suite No
#Units F
Tenant Name D); • y(,� D&�TsT>^ j
2. Description of Work
Use
Valuation $
Extg Sq Ft New/Added Sq Ft �® Total Sq Ft
# Stories
r New Add R Alter [— Demo
Check Appropriate Box for Applicant/Notification
r; 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City State F_
Zip �— Telephoner
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_Telephoner
5. Engineer's Name Last
First Lic. No. F�
Engineer's Address
Engineer's E-mail Address
City State F_
Zip F—'. Telephone
DZ 6. Contractor's Name Last PEX FIRE SYSTEMS First F Lic No. 732396 Class C-16
Contractor's Address
Contractor's E-mail Address
961 WEST MACARTHUR BLVD
marc@apexfiresys.com
City SANTA ANA State CA
Zip 92704 Telephone 949-337-9679
OFFICE USE ONLY �%(Q 2 1"�``• PERMIT NO. i ' O l
TYPE OF CONSTRUCTION
PLAN CHECK NO. I�%
OCCUPANCY - GROUP
PLAN CHECK FEE $
r , n. , eV 1