HomeMy WebLinkAboutF2021-0081 - Permit ApplicationPrint Form
Please print 3copies
Associated Building Permit #
1. Project Address (Not mailing
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
120171 Bayview Dr, Newport Beach CA 92660
Tenant Name 1
2. Description of Work
IResidential Fire Sprinkler System
x,
Extg Sq Ft F_ New/Added Sq Ft
r New r Add r- Alter r" Demo
rX Fire Sprinkler r- Fire Alarm r- Fire Misc
Check Appropriate Box for Applicant/Notification
Total Sq Ft 3,588
Floor Suite No
# Units
Use I
Valuation $ 3,000
# Stories I
I— 3. Owner's Name Last
First F_
Owner's Address
Owner's E-mail Address
City �—
State F—
Zip �— Telephoned
r- 4. Architect/Designer's Name
Last
First Lic. No.
Architect/Designer's Address
Architect/Designers E-mail Address
City i
State F
Zip Telephoned
r' 5. Engineer's Name Last
First F Lic. No.
Engineers Address
Engineer's E-mail Address
City
State F
Zip I TelephoneF—
jX 6. Contractor's Name Last Moreno First Eduardo Lic. No. 950739 Class C-16
Contractor's Address
Contractor's E-mail Address
28568 Lantern Park Lane
LSalazar@LSEFire.com
City Menifee
State CA
Zip 92584 Telephone 951-274-0734
OFFICE USE ONLY
PERMIT NO. • f,
TYPE OF CONSTRUCTION�0'�c
,
PLAN CHECK NO.
OCCUPANCY - GROUP•
PLAN CHECK FEE $
"A-Upj 1 F$1 V " 60f—�f I t