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Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
j)Z Fire Sprinkler (— Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
1ST 150
5000 BIRCH STREET
POUR VIDA RESTAURANT # Units
Tenant Name
2. Description of Work
Use RESTAURANT `E,
DD AND RELOCATE FIRE SPRINKLERS FOR NEW J 24 HEADS
Valuation $ ,000.00
Extg Sq Ft New/Added Sq Ft Total Sq Ft
# Stories
j- New r Add OZ Alter i— Demo
V/
Check Appropriate Box for Applicant/Notification
r 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City
State Zip Telephone
r 4. Architect/Designer's Name Last
l— First I s— Lic
No. F
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
city
State �i Zip F Telephoned
r 5. Engineer's Name Last
First F— Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State F___ Zip F_ Telephoned
GZ 6. Contractor's Name Last PEX FIRE SYSTEMS First Lic No. 732396
Class C-16
Contractor's Address
Contractor's E-mail Address
961 WEST MACARTHUR BLVD
marc@apexfiresys.com
City SANTAANA
State CA Zip 92704 Telephone 49-337-9679
OFFICE USE ONLY
\ S� PERMIT NO.
TYPE OF CONSTRUCTION
p�
I
Q, U l L 1 �J� PLAN CHECK NO.
,),CCUPANCY - GROUP
VVV PLAN CHECK FEE $