HomeMy WebLinkAboutF2021-0074 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach -Building Division
Please print 3 copies 2021 � W -f q
Associated Building Permit # r?�; Fire Sprinkler F_ Fire Alarm r`, Fire Misc
1
Address (Not mailing address)
Poinsettia Ave
Tenant Name
2. Description of Work
sprinklers for new MFR (40 sprinklers)
Extg Sq Ft New/Added Sq Ft F----'; Total Sq Ft r
F_ New F - Add r-5 Alter r`j Demo
Floor Suite No
# Units
Use
Valuation $ 7,000
# Stories
Check Appropriate Box for Applicant/Notification
F 3. Owner's Name Last F�
First
Owner's Address
Owner's E-mail Address
r
City r — State
F Zip —', Telephone
Fx-', 4. Architect/Designer's Name Last Vo
FirstJohn Lic. No.�:
Architect/Designer's Address
Architect/Designer's E-mail Address
526 N Shadydale Ave
fireguardss@gmail.com
City West Covina State
CA Zip 91790 Telephone 714-310--0194
F-- 5. Engineer's Name Last
First —� _ Lic. No.
F
Engineer's Address
Engineer's E-mail Address
City State
Zip F Telephone
X16. Contractor's Name Last Fireguard Sprinkler Systems First Lic. No.992002 Class 16
Contractor's Address
Contractor's E-mail Address
7907 Leeds Street
fireguardss@gmail.com
_ _ -
City Downey State
CA Zip 90242 Telephone 714-310-0194
OFFICE USE ONLY
_11"4 lu'✓ / PERMIT NO. '
TYPE OF CONSTRUCTION
�yy� �/�
�/� l 3 PLAN CHECK NO. �' w
OCCUPANCY- GROUP
��.� 4yq PLAN CHECK FEE $