HomeMy WebLinkAboutF2022-0076 - Permit Application (4)Print Form Worksheet for Fire Permit Application
City of Newport Beach - Building Division ,,�
Please print 3 copies S
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Associated Building Permit # r Fire S rinkler
p F_ Fire Alarm Fx Fire Misc
1. Project Address (Not mailing address) Floor Suite No
2888 Bayshore Dr., Newport Beach, CA 92663 � ��
Tenant Name # Units (
2. Description of Work
Design a 4"PVC CL 200 underground private fire service in accordance with 2019 NFPA 24. Use Commercial
Extg Sq Ft F_ New/Added Sq Ft F— Total Sq Ft F— Valuation $ 1,200.00
FX_ New r Add r Alter r Demo # Stories
Check Appropriate Box for Applicant/Notification
(x 3. Owner's Name Last Goetz First Andrew
Owner's Address
Owner's E-mail Address
2855 E. Coast Highway, Ste. 234
City Corona Del Mar State CA Zip 92625 Telephone (949) 637-8221
F_ 4. Architect/Designer's Name Last
Architect/Designer's Address
City
First
Lic. No.
Architect/Designer's E-mail Address
State �— Zip F TelephoneF—
ix 5. Engineer's Name Last IVu First Anthony
Lic. No. 1038755
Engineer's Address Engineer's E-mail Address
9559 Nightingale Ave ifire rotectiondesi ig
n@gmaii.com
g @gmail.com
City Fountain Valley State CA Zip 92708 Telephone (714) 234-9633
fx 6. Contractor's Name Last Nguyen First Vincent Lic. No. 0084661 Class C16
Contractor's Address Contractors E-mail Address
9182 Alwick Circle xfire rotection rou P g p@gmail.com
City Garden,Grove State CA Zip 92841 Telephone (714) 231-5108
OFFICE USE ONLY
TYPE OF CONSTRUCTION
OCCUPANCY- GROUP
PERMIT NO. �i,/L3.� 0070
PLAN CHECK NO. All 1,024""
ZOZL PLAN CHECK FEE $