HomeMy WebLinkAboutF2023-0172 - Permit ApplicationWorksheet for Fire Permit Application
Print Form �72 G ZI / City of Newport Beach - Building Division
Please print 3 copies %
Associated Building Permit # r Fire Sprinkler (x Fire Alarm j` Fire Misc
1. Project Address (Not mailing address)
393 Hospital Road South
Tenant Name tria Senior Living
2. Description of Work
hange of address from 393 Hospital Road to 393 Hospital Road South
Project is complete and f naled.
Extg Sq Ft F New/Added Sq Ft F Total Sq Ft
r— New r— Add r Alter r— Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
# Units F
Use
Valuation $
# Stories F
(- 3. Owner's Name Last
First �®
Owner's Address
Owner's E-mail Address
City �
State F— Zip F_ Telephoned
I— 4. Architect/Designer's Name Last
First F Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City
State F_ Zip F— Telephone
r S. Engineer's Name Last
First F Lic No. F
Engineer's Address
Engineer's E-mail Address
City �
State F_ Zip F TelephoneF—
[K 6. Contractor's Name Last orres
First Ryan Lic. No. 1069002 Class 10
Contractor's Address
Contractor's E-mail Address
1601 W Orangewood Ave
rtorres@adfiresprinklers.com
City Orange
State CA Zip 2868 Telephone714-714-1884
Zz1I/3 ' 0 �1 Ci
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. Q t'jll')LT —0 7
OCCUPANCY - GROUP
PLAN CHECK FEE $