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Please print 3 copies
Associated Building Permit#
Worksheet for Fire Permit Application p4 Eā¢
City of Newport Beach - Building Division '9
F_ Fire Sprinkler r Fire Alarm r Fire MisC
1. Project Address (Not mailing address)
1470 JAMBOREE RD.
Tenant Name CHASEBANK
2. Description of Work
Fire AlarmT/I , 1 NEW DEVICE
Extg Sq Ft F_ New/Added Sq Ft I ā Total Sci Ft
Fx New r Add r Alter r Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
# Units I
Use
Valuation $ 4196
# Stories F
r 3. Owner's Name
Last
First F
Owner's Address
Owner's E-mail Address
City
State Zip
[ā Telephoned
r 4. Architect/Designer's Name Last
First F Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City
State F Zip
r- Telephone
r 5. Engineer's Name
Last
First Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State F_ Zip
F- Telephoned
r 6. Contractor's Name
Last ADT COMMERCIAL
First F_- Lic. No. 1065604 Class C10 - C16
Contractor's Address
Contractor's E-mail Address
210 W. BAYWOOD AVE.
SEYEDAHRAR@ADT.COM
City Orange
State CA Zip
92765 Telephone F14-685-8133
OFFICE USE ONLY
PERMIT NO.
I
Q
TYPE OF CONSTRUCTION
PLAN CHECK NCIaI
OCCUPANCY - GROUP
PLAN CHECK FEE $