HomeMy WebLinkAboutF2015-0267 - Permit Application139ee-Wesr CuarrHigway
Tenant Name
Please print 3 copies
Associated Building Permit #
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Worksheet for Fire Permit Application Gci 3lo20
City of Newport Beach - Building Division
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1. Project Address (Not mailing address)
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Neuroscience Institute
3rd
# Units
Suite No
340
2. Description of Work
Fire Alarm System Addition
Extg Sq Ft 11,069
New/Added Sq Ft 0 Total Sq Ft 11,069
f' New 3Z Add IT Alter l Demo
Use I __ .......
Valuation $ 4,635.00
# Stories
Check Appropriate Box for Applicant/Notification
1.T 3. Owner's Name Last
Owner's Address
First'
Owner's E-mail Address
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City ( _... _.. _... State _...._ Zip' _. Telephoned .._ ......
fl 4. Architect/Designer's Name Last First' Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
• City
_.. State Zip �..
Telephone'
f5 5. Engineer's Name Last
Engineer's Address
Stapleton First Collin Lic. No.
Engineer's E-mail Address
413747
9531 Milliken Ave. ICStapleton@trisystems.com
City Rancho Cucamonga State CA Zip 191730 Telephone1(909)390-8392
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6. Contractor's Name Last I..__ -112 (_ SirSTW(. , First I Lic. No. '; Class
Contractor's Address Contractor's E-mail Address
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City 1A�,rA �,.(gy to l O&JCIAState
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I ` U '... Zip .... 1 ( �I '1-30 Telephone �0 ' Ci0 '5Y/I -
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OFFICE USE ONLY PERMIT NO. ¶ l
TYPE OF CONSTRUCTION PLAN CHECK NO
OCCUPANCY - GROUP PLAN CHECK FEE $
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