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Worksheet for Fire Permit Application
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City of Newport Beach - Building Division
Please print 3 copies � 3 C� � !7 1 I ' � s� t 2�3
Associated Building Permit # XC2023-0054 1FX_ 1 Fire Sprinkler r Fire Alarm F_ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
1401 Avocado Avenue, Newport Beach, Ca. 92660 F 705
Tenant Name Newport Medical it vei"T gyp -. �,'yv`„ �2,,,� �- `t #Units
2. Description of Work 1
Fire Sprinkler Tenant Improvement (Relocate 13 Fire Sprinkler Heads) Use Comm
Extg Sq Ft F— New/Added Sq Ft �— Total Sq Ft Valuation $ 9,300.00
F_ New r Add r Alter r Demo # Stories F
L,necK Appropriate 13ox for Applicant/Notification
F_ 3. Owner's Name Last
Firstr—
Owner's Address
Owner's E-mail Address
City
State r—
ZIP I Telephone
F_4. Archite Designer' Name
Last Robles
First Argel Lic. No. 577621
Archite esigner' Address
Architectt esigner' E-mail Address
1075 W. Lambert Road
larobles@coscofire.com
City Brea
State Ca.
Zip 92821 Telephone 714-989-1800
f 5. Engineer's Name Last
First Lic No. �—
Engineer's Address
Engineer's E-mail Address
City
State
Zip �— Telephone�—
F 6. Contractor's Name Last Cosco Fire Protection Inc.
First �— Lic No. 577621 Class C-16
Contractor's Address
Contractor's E-mail Address
1075 W. Lambert Road
fmone@coscofire.com
City Brea
State Ca.
Zip 92821 Telephone 714-989-1755
OFFICE USE ONLY
PERMIT NO.L02'jj• t�21
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $