HomeMy WebLinkAboutF2022-0219 - Permit Application��Prir�t Fonn
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
jX Fire Sprinkler F Fire Alarm r Fire Misc
42EW�kJ
0 0
1. Project Address (Not mailing address)
Floor
Suite No
126 Tidal Surf
_ F—
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Tenant Name F
# Units
III �-
2. Description of Work
Use
Fire sprinklers for new second floor addition ;5 sprinklers)
i
Valuation$
1,5oo
Extg Sq Ft �—s�.__..�... New/Added So.Ft i _Total SG Ft
#Stories
f 2
New I—Addr'`, Alter F_Demo
-
Check appropriate Box for Appiicant/Notification
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17 ?. Owner's Name
Last r�
First
C ,Owners Address
E-mail Address
_
(Owner's
City
—.�.�
State F_
Zip r— -.._ Telephone,
fX 4'Architect/Designer's
Name Last ivo
First John Lic. No.�— '
Architect/Designer's Address
Architect/Designer's E-mail Address
1
1526 N Shadydale Ave
r
_
fireguardss@gmail.com
City West Covina
State CA
Zip 91790 Telephone 714-310 0194
(` 5. Engineer's Name
Last
Firstt Lic No.�
Engineer's Address
Engineer's E-mail Address
City _. _
State I—
Zip +'— Telephoned-- —
[X 6. Contractor's Name
Last Fireguard Sprink!er
_ First �� -. Lic No. 992002 _... Class 1.6
Contractors Address
Contractor's E-mail Address
7907 Leeds Street
fireguardss@gmail.com
City (Downey
�(—�--
State CA
Zip 90242 Telephone 714-310-0194 +
6
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OFFICE USE ONLY ' 1l' rt✓` s�
TYPE OF CONSTRUCTION
------
PERMIT NO.
PLAN CHECK NO. �I
OCCUPANCY - GROUP
1 p/
PLAN CHECK FEE $
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