HomeMy WebLinkAboutF2022-0457 - Permit ApplicationWorksheet for Fire Permit Application
RrintFgrrlr City of Newport Beach - Building Division @
Please print 3 copies
Associated Building Permit # r Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
11806 BERYL LANE
Tenant Name NEW RESIDENCE
2. Description of Work
FIRE SPRINKLERS
25 HEADS
Extg Sq Ft F_- New/Added Sq Ft F_ Total Sq Ft
r New r Add r Alter r Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
# Units F—
Use
Valuation $ 2500
# Stories I1
i- 3.Owner's Name
Last First F_
Owner's Address
Owner's E-mail Address
City
State F_ Zip I— Telephoned
F_ 4. Architect/Designer's Name Last First �— Lic. No.l
Architect/Designees Address
ArchitectlDesigner's E-mail Address
City
State �— Zip F TelephoneF
r 5. Engineer's Name
Last First F— Lic. No. �-
Engineer's Address
Engineer's E-mail Address
City
State F__ Zip F_ Telephoned
FX-6. Contractor's Name
Last CASEY First MONTY Lic. No. 876004 Class C-16
Contractor's Address
Contractor's E-mail Address
1101 KINGSTON DR
FIREPROOFMC@GMAIL.COM
City LA HABARA
State CA Zip 90631 Telephone 714-476-5370
OFFICE USE ONLY
4-
PERMIT NO. 1- Z022- 04J %
TYPE OF CONSTRUCTION — PLAN CHECK NO.�Z�2 �' Z Iti L
OCCUPANCY- GROUP
PLAN CHECK FEE $