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Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach -Building DivRoll-
FX-
Fire Sprinkler r Fire Alarm F Fire Misc
1. Project Address (Not mailing address) Floor Suite No
660 Newport Center Or Q� w 4th 400
Tenant Name Satellite Healthcare # Units �s
2. Description of Work
Use Office
Fire Sprinkler TI - 3 sprinklers
City Irvine
Valuation $ t t So
Extg Sq FtF New/Added Sq Ft F Total Sq Ft �—
Architect/Designees Address
Architect/Designer's E-mail Address
# Stories
New r Add
r )C Alter � Demo
F_ 5. Engineer's Name
Check Appropriate Box for Applicant/Notification
3. Owner's Name
Last The Irvine Co. First �—
Owner's Address
Owner's E-mail Address
101 Innovation
City Irvine
State CA Zip 92617 Telephone
r 4. Architect/Designer's Name Last First F— Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City
State F Zip F TelephoneF_
F_ 5. Engineer's Name
Last First F Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State I Zip F_ Telephone-
r 6. Contractor's Name
Last Fire Protection Specialists, Inc First Robert Anderson Lic. No. 464915 ClassF-16s
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
PERMIT NO. C 7'021,- Del
TYPE OF CONSTRUCTION PLAN CHECK NO. t %OLy
OCCUPANCY - GROUP
v��yj PLAN CHECK FEE $