HomeMy WebLinkAboutF2019-0500 - Permit ApplicationWorksheet for Fire Permit Application ?4907_R0/t7
Print Form . City of Newport Beach - Building Department
Please print 3 copies F,20/9.0500
Associated Building Permit # X2019-2099 __.. r Fire Sprinkler r, Fire Alarm Fire Misc
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1. Project Address (Not mailing address) Floor Suite No
4041 Macarthur Blvd.. Newport Beach CA 92660 4th F�
Tenant Name # Units
Owner's E-mail Address
2. Description of Work
Use
tall of new smoke detectors and new visual and audio/visual notification devices.
65 DEVICES
Name Last Chakma First Pannee Lic. No.
Architect/Designer's Address
Valuation $ 12,625.00,;
Extg Sq Ft F New/Added Sq Ft F Total Sq Ft 25,653
City Ontario
State CA Zip 91761 Telephone 909-957-5200
r 5. Engineer's Name
# Stories 5
r New r Add r. Alter r Demo
-
Check Appropriate Box for Applicant/Notification Information
r
3. Owner's Name
Last WW,LLC First',
Owner's Address
Owner's E-mail Address
115 W.18TH Street
City New York State NY Zip 10011 Telephone 312-714-5840
r', 4. Designer's
Name Last Chakma First Pannee Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
1354 S. Parkside PI.
City Ontario
State CA Zip 91761 Telephone 909-957-5200
r 5. Engineer's Name
Last First F Lic. No.
Engineer's Address
Engineer's E-mail Address
City I
StateF Zip F7777Telephone
jx, 6. Contractor's Name
Last HCI Systems Inc First F Lic. No. 905493 Class Fc7c10c16
Contractor's Address
Contractor's E-mail Address
1354 S. Parkside PI.
EngS@hcisystems.net
City Ontario s State CA Zip 961 Telephone 909-957-5200
17
OFFICE USE ONLY
PERMIT NO. f ) c))7
TYPE OF CONSTRUCTION PLAN CHECK NO. d0U7^,3d1cq
OCCUPANCY - GROUP
PLAN CHECK FEE $
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