HomeMy WebLinkAboutF2022-0018 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
1. Project Address (Not mailing
San Miguel
Worksheet for Fire Permit Application 90,n�,,
City of Newport Beach - Building Division ��pa? -00 ly360 S,NV MIGUEL.�DR
II Z ' t Fire Sprinkler Fx Fire Alarm F _ Fire Misc
Tenant Name Hoag Medical Group Internal Medicine T.I.
2. Description of Work
& Generator Upgrade
C1Aj C - -2
Extg Sq Ft F New/Added Sq Ft F Total Sq Ft rF�
F _ New FX, Add (-1 Alter r Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
I
#Units 1 7
Use
Valuation $ 2500
# Stories
F_ 3. Owner's Name
Last First
Owner's Address
Owner's E-mail Address
City _ .,
State �— Zip �— Telephoned-
FX4. Arch itect/Designer's
Name Last Ferris First Kelly Lic. No. 750781
Architect/Designer's Address
Architect/Designer's E-mail Address
8724 Millergrove Dr.
kellyf@weprotectall.com
City Santa Fe Springs
State CA Zip 90670 Telephone 562-325-6426
r 5. Engineer's Name
- Lic. No.
Last First F_
Engineer's Address
Engineer's E-mail Address
City
I
.. State �— Zip I Telephoned',
FX, 6. Contractor's Name
Last Ferris First Felly _ _... Lic. No. 750781 _' Class C 10 _.
Contractor's Address
Contractor's E-mail Address
8724 Millergrove Dr.
kellyf@weprotectall.com
City Santa Fe Springs
State CA Zip 90670 Telephone 562-325-6426
OFFICE USE ONLY
PERMIT NO. E F�7Jhi ' Q�I
TYPE OF CONSTRUCTION PLAN CHECK NO. ()CA 5 - Zvi
OCCUPANCY- GROUP
1 r PLAN CHECK FEE $