HomeMy WebLinkAboutF2021-0131 - Permit ApplicationWorksheet for Fire Permit Application
� City of Newport Beach - Building Division F ZO Z I ^ 0131+
Please print 3 copies
Associated Building Permit # I OZ Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address) j Floor Suite No
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179E DOvE STAeCT I
Units �—
Tenant Name#
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2. Description of Work
Use/
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r 4. Architect/Designer's Name
Last
Valuation $ �, oo,
Fxdg Sq Ft �— New/Added Sq Ft r Total Sq Ft F
City
State F_ Zip F_ Telephone—
# Stories F
r New r Add R Alter r Demo
Engineers Address
Check Appropriate Box for Applicant/Notification
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r 3. Owner's Name Last
� First F_
Owners Address
Owners E-mail Address
City
State F_— Zip F Telephoned—
First [— Lic. No. F
r 4. Architect/Designer's Name
Last
AmhitectIDesigner's Address
AmhitectlDesigners E-mail Address
City
State F_ Zip F_ Telephone—
r 5. Engineer's Name Last
�— First F— Lic. No. �—
Engineers Address
Engineers E-mail Address
City
State F Zip F_ Telephoned
PZ 6. Contractor's Name Last PEX FIRE SYSTEMS First F Lic. No. 732396 Class -16
Contractors Address
Contractors E-mail Address
961 WEST MACARTHUR BLVD
arc@apexfiresys.com
city ANTA ANA
State FA Zip 2704 Telephone 49-337-9679
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OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
W PLAN CHECK NO.
OCCUPANCY -GROUP
PLAN CHECK FEE $
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