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Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
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�— f Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
4000 MacArthur Blvd tt)th , 1000
Tenant Name 4000 MacArthur 9th/10th # Units F
2. Description of Work
Use Office
Fire Sprinkler Tl -100 sprinklers
Preaction sprinkler system - 4 sprinklers
AMY.HIGUCHI@HINES.COM
Valuation $ 9,000
Extg Sq Ft F— New/Added Sq Ft F— Total Sq Ft F_
Zip 07302 Telephone (949) 313-2212
r 4. Architect/Designer's
# Stories 10
(— New r Add r Alter j— Demo
Check Appropriate Box for Applicant/Notification
rN'FA YYYf 1{�AN
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3. Owner's Name
Last Hines
First I
Owner's Address
Owner's E-mail Address
30 Hudson Street
AMY.HIGUCHI@HINES.COM
City Jersey City
State NJ
Zip 07302 Telephone (949) 313-2212
r 4. Architect/Designer's
Name Last First F Lic. No.--
Architect/Designer's Address
Architect/Designer's E-mail Address
City �
State F__
zip F® Telephone—
r 5. Engineer's Name
Last
First F_ Lic. No. F_
Engineer's Address
Engineer's E-mail Address
City �—
State F_
Zip �—' TelephoneF—
F_ 6. Contractor's Name
Last Fire Protection Specialists, Inc First Robert Anderson Lic. No. 464915 Class C-16
Contractor's Address
Contractor's E-mail Address
2810 E. Miraloma Ave
robert@fireprotectionspecialists.com
City Anaheim
State CA
Zip 92806 Telephone714-635-(1500
OFFICE USE ONLY
f
vf f r lN• PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
to PLAN CHECK FEE $