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Print Form Cityof Newport Beach - BuildingDivision
Please print 3 copies
Associated Building Permit # 1628-2021 /X2021-1891 F_ Fire Sprinkler rx— Fire Alarm F_ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
1401 Avacado //�I' 403
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Tenant Name Orange County Fertility T.I. its 7—
2. Description of Work 1
Fire Alarm Tenant Improvement 35 - Devices
Valuation $ 12000
Extg Sq Ft 6500 New/Added Sq Ft Total Sci Ft �—
i— New f— Add # Stories
� Alter r Demo
Check Appropriate Box for Applicant/Notif!cation
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r 3. Owner's Name
Last
First
Owner's Address
Owner's E-mail Address
City
State �—
Zip F_ Telephoned
F_ 4.-Acsb4eGVDes1gner's
Name Last Ferris First Kelly Lic. No. 750781
Architect/Designer's Address
Architect/Designees E-mail Address
8724 Millergrove Dr.
kellyf@weprotectall.com
City Santa Fe Springs
State CA
Zip 90670 Telephone 562-325-6426
r 5. Engineer's Name
Last
First Lic. No. �—
Engineer's Address
n 1 dr
City I
State
Zip F Telephoned
r 6. Contractor's Name
Last Ferris First Kelly Lic No. 750781 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 562-325-6426
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $