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Associated Building Permit #
Worksheet for Fire Permit Application *,.gpo,City of Newport Beach - Building Division
F- Fire Sprinkler lx Fire Alarm F- Fire Misc
1. Project Address (Not mailing address)
849 NEWPORT CENTER DR
Tenant Name Mendocino Farms
2. Description of Work
Irnu i t� i to rntivu.�t�, YIKL ALAKM �,YS I tM 4{ J J 1
Extg Sq Ft �— New/Added Sq Ft F Total Sq Ft F
F- New F- Add Fx Alter F- Demo
t.neCK Appropriate box for Applicant/Notification
Floor Suite No
849
}r�J, # Units F�
Use
Valuation $ 10,000.00
# Stories F
F 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City I
State F- Zip F_ Telephoned
F- 4. Architect/Designer's Name
Last First F Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F— Zip �— Telephoned
F- 5. Engineer's Name Last
First �— Lic No. F_
Engineer's Address
Engineer's E-mail Address
City �
State F— Zip F_ Telephoned
F-" 6. Contractor's Name Last INTERFACE SYSTEMS First F Lic. No. F69046 Class C10
Contractor's Address
Contractor's E-mail Address
3750 SCHAUFELE AVE SUITE 200
kelley.santacruz@interfacesys.com
City LONG BEACH
State CA Zip 90808 Telephone562-353-4680
OFFICE USE ONLY
PERMIT NO. 6
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $