HomeMy WebLinkAboutF2022-0172 - Permit ApplicationWorksheet for Fire Permit Application a9
City of ewport Beach - Building Division `,lk
Please print 3 copies c„op .
Associated Building Permit # Fire Sprinkler ❑ Fire Alarm I] Fire Misc
1. Project Address (Not mailing address) Floor Suite No
410a 30o 1
Tenant Name Lfrq\mv%io oct 1 tC41 #Units L
2. Description of Work .-
use _ $ s
City IrNno
lht rctocoLhon of (p� a fisting fire SprinKters c!� 1�t _heu,r sdslll
_..
Last _ First , Lic. No.
and U nr
Architect/Designer's E-mail Address
Valuation$ 2,200•
Extg Sq Ft New/Added Sq Ft Total Sq Ft 3, 52CD
------� I_
-i
New [Add � Alter [Demo
# Stories
I ”
Check Appropriate Box for Applicant/Notification �.
[713. Owner's Name Last uZtnby First $trtanda
Owner's Address
Owner's E-mail Address
IBZoI Von Korman W\,tMM
City IrNno
j State � Zip o1Zco12 ',. Telephone g4q.331. 1491
4. Arch itecVDesig ner's Name
Last _ First , Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City -_- _ _ - State —. Zip F_ Telephone--
5. Engineer's Name Last
Lic. No.
FirstF----
Engineer's Address
Engineer's E-mail Address
i
City _
State—, Zip �I Telephoner
L/6. Contractor's Name Last JohYiSion First 30hn Lic. No. G29993' Class C-lco
.-_.._... - --- - --- -'
Contractor's Address
Contractor's E-mail Address
179 ttoymar `rZOctol, S\Af, N
johnOauproFitennc•com
City 0CeCtn3ide
State 16' — Zip g205b Telephone R51. Zc4 391
OFFICE USE ONLY
lr L� PERMIT NO. C•
TYPE OF CONSTRUCTION
l !
PLAN CHECK NO.
OCCUPANCY - GROUP
%�'7 �\ PLAN CHEC
1