HomeMy WebLinkAboutF2018-0618 - Permit ApplicationWorksheet for Fire Permit Application
Print.Fbrm " City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit #
FX- Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
1721 BLVD
E BALBOA
Tenant Name BAST RESIDENCE # Units F-
City—�
2. Description of Work
r- 4. Architect/Designees Name Last
First F— Lic. No. —'
Use
FIRE SPRINKLERS 35 HEADS
- - -- -'
State F Zip F7777 TelephoneF-
Valuation $ 3,500
Extg Sq Ft New/Added Sq Ft Total Sq Ft �,
Engineer's Address
Engineer's E-mail Address
# Stories
FX- New F- Add r Alter j— Demo
I -
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last i�
- First
Owner's Address
Owner's E-mail Address
City—�
State 7— Zip F TelephoneF�
r- 4. Architect/Designees Name Last
First F— Lic. No. —'
Architect/Designer's Address
Architect/Designees E-mail Address
City
State F Zip F7777 TelephoneF-
1— 5. Engineer's Name Last
First F Lic. No. F
Engineer's Address
Engineer's E-mail Address
City � --
State F-- Zip F—Telephone��
T' 6. Contractor's Name Last CASEY
First MONTY Lic. No. 876004 Class F 16
Contractor's Address
Contractor's E-mail Address
1101 KINGSTON DR
FIREPRDOFMC@GMAIL.COM
City HABRA
State CA Zip 90631 Telephone714 476-5370
OFFICE USE ONLY
��-� PERMIT NO.
$
TYPE OF CONSTRUCTION
�$�er� 1�j PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $