HomeMy WebLinkAboutF2021-0245 - Permit Application- Worksheet for Fire Permit Application
Print Fonr o
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit #
X2019-4076 - ri Fire Sprinkler r Fire Alarm F7 Fire Misc
1. Project Address (Not mailing address) Floor Suite No
12309 Santiago Drive j r—',
Tenant Name I #Units F
2. Description of Work
Use
Fire sprinklers for garage/gym (10 heads)
Valuation $ 2,500-_
Extg Sq Ft F_New/Added Sg Ft r_--�._ -, Total Sg Ft �—
#Stories It
j- New r', Add F7 Alter F-Demo
Check Appropriate Box for Applicant/Notification
I nf�rm �4irn
F-I 3.Owner's Name
Last F
First F,�.
Owner's Address
Owners E-mail Address
I
City
State r Zip F Telephoner_.__- -
r4. Architect/Designer's Name Last Vo
First John Lic. No. --
Architect/Designer's Address
Architect/Designer's E-mail Address
15 6 adydale Ave
fireguardss@gmail.com
City West Covina
State CA
Zip 91790 Telephone 7143100194
r' 5. Engineer's Name
Last
First F Lic No.�
Engineer's Address
Engineer's E-mail Address
City
_
State {y
-_-_ ... ...
Zip F_ TelephoneF_
r' 6. Contractor's Name
Last Fireguard Sprinkler Systems
First F Lic No. 992002
Class F
Contractors Address
Contractor's E-mail Address
7907 Leeds Street
fireguardss@gmail.com
City Downey
State CA
Zip 90242 Telephone 7143100194
OFFICE USE ONLY
PERMIT NO. 2
M LA
L
FYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $