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Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Fire Sprinkler 1._ Fire Alarm F Fire Misc
`1. Project Address (Not mailing address) Floor Suite No ^!
i42? Santa Ana Ave
t Tenant Name � _ #Units i i
I _
2. Description of Work
Fire sprinklers for SF (42 heads)
Extg Sq Ft F— New/Added Sri Ft1
Teta! Sci Ft
t. New r-- Add F Alter 1-- Demo
Use
Valuation $ 18,000
#Stories 12__
a
I Check Appropriate Box for Applicant/Notification
J tlifa statian _ ---
P 3, Owner's Name Last First
Owner's Address Owners E-raai? Address
I I
City l i ,,.' r.,..._._.._____ _....._
_. State Zit, i Telephone -
X 4. Architect/Designer's Name Last1Va nsi!ohn LicNoT
Architect/Designer's Address Architect/Designer's E-mai! Address
06 N ShadydaleAve it eauardG rPgmail.corn
:ity ibVestCovina ,a.
t _ ._:r 91790 Telephone. / 4-310-0194
� I
5. Engineer's Name Last i First;
i
-noineer's Address
Ecgr:eer's E-mail Aadress
i
City i Cr i 7P.R- rl le �.
Lic. No.
X IS, Contractor's Name Last,F irecuard Sp 'nK.er SystemF�s si Lic No. 992002 Classel6
i,
i Contractors Address Son?;acmr's E-mail Address
17907 Leeds Street ; ._.. __... `---" .`_..--`--
eguards Cgmoil.com
city Downey state I 14 _ Zip 190242 Telephone 714-310-0194
i
OFFICE USE ONLY k I PERMIT NO.
TYPE OF CONSTRUCTION __. l \��` %,qq oLgN CHECK NO. n$`
OCCUPANCY - GROUP
0D7-Y PLAN CHECK FEE $----..----- _-.