HomeMy WebLinkAboutF2021-0281 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit
Worksheet for Fire Permit Application
4 City of Newport Beach - Building Division
,2021-0793 rl Fire Sprinkler r Fire Alarm r! Fire Misc
1. Project Address (Not mailing address)
360 San Miguel DR.
Tenant Name HMG Internal Medicine
2. Description of Work
Fire Sprinkler Tenant Improvement (Relocate 50 Heads)
Extg Sq Ft New/Added Sq Ft F Total Sq Ft F
F- New r Add r Alter j— Demo
Check Appropriate Box for Applicant/Notification
Floor
3RD.
# Units
Suite No
F3OO;
Use (Office
Valuation $ 4,500.00
#Stories rto
F-', 3. Owner's Name Last NCMB NO 4 LLC
First,
Owner's Address
Owner's E-mail Address
City State F_�
Zip F_— Telephone_(
F_ 4. Architect/Designees Name Last Simon First Pake Lic. No.577621
Architect/Designer's Address
ArchitecUDesigner's E-mail Address
1075 W. Lambert Road
jsimon@coscofire.com
- ---
City Brea State Ca
Zip 92821 Telephone 714-989-1800 j
F_ 5. Engineer's Name Last
First F_ Lic. No.
F_�
Engineer's Address
Engineer's E-mail Address
City I State—;
^Zip �— Telephone—'I
F 6. Contractor's Name Last Cosco Fire Protection Inc. li First ��Lic. No. 577621 '�, ClassC-16
Contractor's Address
Contractor's E-mail Address
1075 W. Lambert Road
fmone@coscofire.com
City Brea State Ca
Zip 92821 Telephone714-989-1755
PERMIT NO.
OFFICE USE ONLY W621 O
TYPE OF CONSTRUCTION ('V .
✓��
✓� PLAN CHECK NO.
6
OCCUPANCY- GROUP
PLAN CHECK FEE $