HomeMy WebLinkAboutF2019-0463 - Permit ApplicationWorksheet for Fire Permit Application�ge
r:;pririf Form City of Newport Beach -Building Department
Please print 3 copies
Associated Building Permit # Fire Sprinkler r'; Fire Alarm r, Fire Misc
1. Project Address (Not mailing address) Floor Suite No
2555 Vista Del Oro1 st F—
It Units
Tenant Name Boys Girls Club
and
2. Description of Work
17701 Cowan Suite 110
Use
Installation of new visual and audio/visual notification appliances. Installation of new Duct
smoke detectors. Removal and reinstallation of existing pull stations. 23 devices
Name Last First Lic. No. ;
Architect/Designees Address-
V luation $ 5,388.75 '.,.
Extg Sq Ft 11,874 SO FT New/Added Sq Ft F Total Sq Ft F
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City Ontario
...
State CA Zi 91761 Telephone 909-957-5200
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F-, 5. Engineer's Name
#Stories I1
r New j— Addr; Alter r Demo
Engineer's E-mail Address
Check Appropriate Box for Applicant/Notification Information
3. Owner's Name
Last goys and Girls Club First
Owner's Address
Owner's E-mail Address
17701 Cowan Suite 110
City Irvine
Stateca Zip 92614 _ Telephoned
r! 4. Architect/Designer's
Name Last First Lic. No. ;
Architect/Designees Address-
Architect/Designer's E-mail Address
1354 S. Parkside PI.
City Ontario
...
State CA Zi 91761 Telephone 909-957-5200
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F-, 5. Engineer's Name
Last Lni�� First ���j(( Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State Zip Telephoned
r;6. Contractor's Name
Last HCI Systems Inc First Lic. No. 905493 Class c7c10c16 ,
Contractor's Address
- Contractor's E-mail Address
1354 S. Parkside PL
Eng5@hcisystems.net
City Ontario
State CA Zip 91761 Telephone 909-957-5200
OFFICE USE ONLY
PERMIT NO. ZtaGC (�� Ej3
TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY - GROUP
�� �! /11 r/1 _/ Z �Z PLAN CHECK FEE $
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