HomeMy WebLinkAboutF2021-0623 - Permit Application-r1-0 - C)6z 3 .SG()0 Gi re; H S T
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Worksheet for Fire Permit Application
Print Form City of Newport Beach - Building Division
Please print 3 copies D 6 5 Z - C� /Fp1iNP
Associated Building Permit # Fire Sprinkler Fire Alarm Fire Misc
1. Project Address (Not mailing address) Floor Suite No
5000 Birch Street
Tenant Name 8th Floor Corridor & RR
# Units F
_-...._-
2. Description of Work _
Fire Sprinkler TI (8) heads Use B
Valuation $ 13,200.00
Extg Sq Ft 1,693 � New/Added Sq Ft � Total Sq Ft
# Stories Flo(— New Q Add (— Alter F_ Demo
Check Appropriate Box for Applicant/Notification
F_ 3. Owner's Name Last �—
First I
Owner's Address
Owner's E-mail Address
C .b sX7 +\ 33
City I �� ���
State
Zip 4i Telephone
(_ 4. Architect/Designer's Name Last
First F Lic.
NoF�
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �—
Zip F Telephone
F_ 5. Engineer's Name Last
First F Lic. No. F
Engineer's Address
Engineer's E-mail Address
City--
State
Zip F Telephone
Q 6. Contractor's Name Last aekel First Steve Lic. No. 599761
Class C36,10,16
Contractor's Address
Contractor's E-mail Address
1170 E. Fruit Street
sjaekel@firesafetyfirst.com
City Santa Ana
State CA
Zip 92701 Telephone 714-329-7110
OFFICE USE ONLY
PERMITNO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $