HomeMy WebLinkAboutF2023-0151 - Permit ApplicationWorksheet for Fire Permit Application �4900t,
Print Form z
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # I �G ' F- Fire Sprinkler r Fire Alarm F_ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
5000 Birch Street 1st -
Tenant Name # Units
2. Description of Work
Provide labor to install 3 Notification Devices.
Extg Sq Ft New/Added Sci Ft EI Total Scl Ft
FX, New [-; Add ❑ Alter ❑ Demo
Check Appropriate Box for Applicant/Notification
Use
Valuation S 7,275.00
# Stories
F- 3. Owner's Name Last Insurance Company USA First John Hancock Life
Owner's Address
Owner's E-mail Address
5000 Birch Street, Suite 120
City Newport Beach State CA
Zip 92660 Telephone—
r 4. Arch itect/Designer's Name Last i
First Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City'' State
Zip Telephone�—
F— 5. Engineer's Name Last
First 7 Lic. No. F
Engineer's Address
Engineer's E-mail Address
City State . F
Zip �� Telephoned
C 6. Contractor's Name Last Nat Diaz First alie - Lic. No. 599761 Class C10,16,36
Contractor's Address
Contractor's E-mail Address
1170 E. Fruit Street
ndiaz@firesafetyfirst.com
City Santa Ana State CA
Zip 92701 Telephone 714-263-2632
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $
?2Ze