HomeMy WebLinkAboutF2022-0176 - Permit ApplicationPrint Form Worksheet for Fire Permit Application 0 oa r
City of Newport Beach - Building Division
Please print 3 copies a ��'
Associated Building Permit # X2022-0583 FX_ Fire Sprinkler r Fire Alarm I— Fire Misc
1. Project Address (Not mailing address) Floor Suite No
5010 Campus Drive 100
Tenant Name Newport Campus Medical Plaza # Units F
2. Description of Work
Add head from existing 1"plug (4). Use
- -- - -
Valuation $ 2,000
Extg Sq Ft F New/Added Sq Ft r Total Sq Ft 406.24
r New
r Add r Alter F- Demo # Stories F7_
Check Appropriate Box for Applicant/Notification
Information
i— 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City �—
State
F___
zip �� Telephoned
_-
r 4. Architect/Designer's Name
Last
First �—' Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
- -
City I
State
............... -.
Zip [ _ Telephoned
r 5. Engineer's Name Last
First Lic. No. F
Engineer's Address
Engineer's E-mail Address
.....
City
State
F
Zip F7777 Telephoned
6. Contractor's Name Last ICJ Suppression, Inc.
First �— Lic. No. 721124
Class C-16
Contractor's Address
Contractor's E-mail Address
205 Lewis Court
construction@cjsuppression.com
City Corona
State
CA
Zip 92882 Telephone 951-735-5560
OFFICE USE ONLY PERMIT NO. 01-1to
TYPE OF CONSTRUCTION6 145� PLAN CHECK NO. bRb5.2o2Y
OCCUPANCY- GROUP n GJt Z0 7,7jj PLAN CHECK FEE $