HomeMy WebLinkAboutF2023-0269 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Department
Please print 3 copies
Associated Building Permit# —KG ;
1. Project Address (Not mailing address)
Life
eE"'°gar
Fire Sprinkler j) Fire Alarm F Fire Misc
:i Floor Suite No
3rd F
Tenant Name IPacific Life # Units r
2. Description of Work
relocation or existing visual and aud-lo-m—sual no i Ication appliances713 —
on the plans, installation of new visual and audio-visual notification appliances marked as "N"
on the olans. en
Extg Sq Ft New/Added Sq Ft �— Total Sq Ft 5071
r- New (" Add X Alter I— Demo
Check Appropriate Box for Applicant/Notification Information
Use
Valuation $ 7127
# Stories I5
F- 3. Owners Name Last Balfour First Sarah
Owner's Address
Owner's E-mail Address
!700 Newport Beach
eng5@hcisystems.net
City Newport Beach �u State CA
Zip 192660 Telephonel949-219-7445
fx 4. Architect/Designer's Name Last !Ramirez
First Gary Lic. No. 905493
Architect/Designees Address
Architect/Designer's E-mail Address
1354 S. Parkside PI.
eng5@hcisystems.net
city Ontario State CA
Zip 91761 Telephone 909-957-5200
r 5. Engineers Name Last First I— Lic. No.
Engineer's Address
Engineer's E-mail Address
City State
1
Zip r— Telephonej
,x 6. Contractor's Name Last !Gomez
First IMiam Lic. No. 05493 Class 'c7c10c16
Contractor's Address
Contractor's E-mail Address
1354 S. Parkside Pl.
Eng5@hcisystems.net
City Ontario State ICA
Zip 191761 Telephone}909-957-5200
OFFICE USE ONLY
PERMIT NO. F20Z 3. 0269
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $