HomeMy WebLinkAboutF2019-0242 - Permit ApplicationIds+nt Falm Worksheet for Fire Permit Application
f19_0 161 , 0 2 City, ewport Beach -Building Division g
Please print 3 copies
Associated Building Permit # r Fire Sprinkler r Fire Alarm (- Fire Misc
1. Project Address (Not mailing address) Floor Suite No
500 Superior Ave 2nd 210
HRC Fertility # Units �-
Tenant Name
2. Description of Work
City Newport Beach
Fire Sprinkler Tl -5 sprinklers 6j�k
Use Medic6lOffice
ArchitecUDesigner's Address
Valuation $ 1250
Extg Sq Ft F— New/Added Sq Ft F Total Sq Ft
State r® Zip F— Telephone-
r 5. Engineer's Name
Last First Lic. No. �—
Engineer's Address
# Stories
F- New r Add FX- Alter (- Demo
1\
Check Appropriate Box for Applicant/Notification
C- 3. Owner's Name
Last Hoag Memorial Presbyterian Hosp First
Owner's Address
Owner's E-mail Address
510 Superior Ave #290
City Newport Beach
State CA Zip 92663 Telephone
r 4. Architect/Designer's Name Last First Lic. No. �—
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
City
State r® Zip F— Telephone-
r 5. Engineer's Name
Last First Lic. No. �—
Engineer's Address
Engineer's E-mail Address
City
State I Zip F TelephoneF—
r 6. Contractor's Name
Last Fire Protection Specialists, Inc First, FRobert Anderson Lic. No. 464915 Class C-16
Contractor's Address
Contractor's E-mail Address
2810 E. Miraloma Ave
robert@fireprotectionspecialists.com
City Anaheim
State CA Zip 92806 Telephone 714-635-6500
OFFICE USE ONLY
��� 6 PERMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY GROUP XZ
-
L/ PLAN CHECK FEE $