HomeMy WebLinkAboutF2020-0465 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
FX Fire Sprinkler F_ Fire Alarm F— Fire Misc
1. Project Address (Not mailing address)
200 Ruby Ave
Tenant Name
2. Description of Work
Fire sprinklers for residential duplex remodel (25 sprinklers)
Extg Sq Ft F New/Added Sq Ft Total Sq Ft
r New F_ Add F-i Alter F_ Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
# Units ��—
Use
Valuation $ 5,000
# Stories
I
F-3. Owner's Name Last First r�
Owner's Address Owner's E-mail Address
city r— State (-----, Zip r Telephoned
(x 4. Architect/Designer's Name Last Vo First Pohn Lic. No.
Architect/Designees Address Architect/Designer's E-mail Address
526 N Shadydale Ave fireguardss@gmaiLcom
City West Covina ' State CA Zip 91790 Telephone 714-310 0194
F_ 5. Engineer's Name Last First F_ Lic. No. I
Engineer's Address Engineer's E-mail Address
City � __. _ State F_'.. Zip F_ Telephoner
(x 6. Contractor's Name Last Fireguard Sprinkler Systems First —j Lic No. 992002 Class F16
Contractor's Address Contractor's E-mail Address
7907 Leeds Street fireguardss@gmaiLcom
City Downey State CA Zip r0242 Telephone 714-310-0194
OFFICE USE ONLY PERMIT NO.
p
TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY- GROUP PLAN CHECK FEE $