HomeMy WebLinkAboutF2023-0401 - Permit ApplicationWorksheet for Fire Permit Application 0�eafPrint F
orm (� City of Newport Beach - Building Division please print 3 copies 4/ � b 6 2
Associated Building Permit # FxZ „` JCI �q Q, q) IfX Fire Sprinkler r- Fire Alarm (- Fire Misc
1. Project Address (Not mailing address) Floor Suite No
----- —
I2309Santiago Drive
Tenant NameF_ -�r #Units
r 2. Description of Work
Use F-
Fire sprinklers for new gym (6 heads)
_- ._.--...-._-. Valuation $ 2.000
Extg Sq Ft F— New/Added Sq Ft I � Total Sy Ft F (�
�i` New [_ Add I #Stories I' —
� Alter � Demo
Check Appropriate Box for Applicant/Notification
r�{ 3. Owner's Name
Last
� First
Owner's Address
Owner's E-mai! Address
amity �-
t
--- State
Zip — -. Telephone—_
(` X,, 4. Architect/Designer's
Name Last No
First .John
Lic. No.
Architect/Designer's Address
Architect'Designei's E-mail Address
526 N Shadydale Ave
fireguardss@gmail.com
-ity West Covina
- State
-
jCA
--
Zio 91790 Telephonel714-310-0194
;
I
)
�F_ S. Engineer's Name
Last (
First s: I_ic. No. F—
Engineer's Address
Engineer's E-mail Address
City
{ 1
State
_
Zip-- Telephone[
6. Contractor's Name
LastF, reguard Sprinkler Systems First Lic No. 1992002
Class 16
Contractor's Address
C.ntractor's E-mail Address
a ?9C7 Leeds Street
_
_ -�-
fireguardss@gmaii.com
City Downey
Stag
!CA -
Zip 90242 Telephone 714-3110-0194
i
OFFICE USE ONLY PERMIT NO.
TYPE OF CONSTRUCTION ___ PLAN CHECK NO.
OCCUPANCY - GROUP - PLAN CHECK FEE $