HomeMy WebLinkAboutF2021-0246 - Permit Application-71
FFrint Form
F Ipase print 3 copies
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Associated Building Permit #
X2019-4079 �: Fire Sprinkler r Fire Alarm r Fire Misc
j1. Project Address (Not mailing address) Floor Suite No
i 12309 Santiago Drive F_ �.
.F
# Units —'.
TenantName
— 2. Description of Work
r—
Use
1 SFlre sprinklers for guest house (8 heads)
9 —
-',
Valuation $ 2,000
Extg Sq Ft F New/Added Sq Ft I Total Sq Ft F--
i
# Stories �'
j New r Add (—' Alter (— Demo
Check Appropriate Box for ApplicantlNotification
I ,_
3. Owner's Name
Last
First
C Owner's Address
Owner's E-mail Address
City �
State
Zip f ----- Telephoner
R (X 4. Architect/Designer's Name Last (Vo
�, First John Lic. No.
9
_... _.
... -- --_--_ - --
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
526 N Shadydale Ave
fireguardss@gmail.com
City West Covina
State CA
Zip 91790 Telephone 7143100194
5. Engineer's Name
Last I
First �- Lic. No.
Fi
Engineers Address
Engineer's E-mail .Address
City
State F
Zip r— — TelephoneF_
r' 6. Contractor's Name
Last Fireguard Sprinkler Systems First I___ Lic No. 992002 Class 16
Contractor's Address
Contractor's E-mail Address i
17907 Leeds Street
fireguardss@gmail.com
City Downey
State CA
Zip 90242 Telephone 7143100194
I
OFFICE USE ONLY
PERMIT NO. w1_�/��6
TYPE OF CONSTRUCTION
PLAN CHECK NO. '"J� L loll
I
iOCCUPANCY - GROUP
PLAN CHECK FEE $