HomeMy WebLinkAboutF2021-0624 - Permit ApplicationWorksheet for Fire Permit Application
Print Form ,; City of Newport Beach - Building Division
Please print 3 copies full — 196 0
Associated Building Permit # ZCV 5? Fire Sprinkler [__ Fire Alarm F_ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
15000 Birch Street Fth
Tenant Name Fth Floor Corridor& RR 4 Units
2. Description of Work
City F State F Zip F-:: TelephoneF
Fire Sprinkler TI (9) heads
Use 1B
Extg Sq Ft1,784 New/Added Sq Ft F Total Sq Ft
Valuation $ 40000
F
F - New VZ, Add Fj After r- Demo
Stories in F
F_ 5. Engineer's Name
Last FirstF Lic. No.
Check Appropriate Box for Applicant/Notification
3. Owner's Name
Last First
Owner's Address
Owner's E-mail Address
7
City F State F Zip F-:: TelephoneF
F! 4. Architect/Designer's
Name Last7 First Lic. No.
1
..... .. ....... __ I F77777F
Architect/Designer's Address
F-7
Architect/Designer's E-mail Address
City
State zip Telephone
F_ 5. Engineer's Name
Last FirstF Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State Zip F_F-7-
Telephone
D? 6. Contractor's Name
Last aekel First Steve Lic. No. 599761 36,10,16
F Class F
Contractor's Address
Contractor's E-mail Address
1170 E. Fruit Street
jsjaekdPfJresafetyfjrst.corn
City ISanta Ana
State CA Zip FW701 TelephoneF 714-329-7110
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY -GROUP
PLAN CHECK FEE $