HomeMy WebLinkAboutF2021-0616 - Permit ApplicationWorksheet for Fire Permit Application o��""°°"e
Print Form City of Newport Beach - Building Division
Please print 3 copies �4 oar•"
Associated Building Permit #
r Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
1924 GALAXY DR F—
Tenant Name WELBOURN RESIDENCE # Units
2. Description of Work
FIRE SPRINKLERS
Use
29 HEADS
Extg Sq Ft 7—New/Added Sq Ft F_— Total Sq Ft
Valuation $ 2900
# Stories
New j Add r Alter � Demo
.1
Check Appropriate Box for Applicant/Notification
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3. Owners Name
Last First —�
Owner's Address
Owner's E-mail Address
City I
State F Zip F_ Telephoned
j- 4. Architect/Designer's
Name Last First F Lic. No.--
Architect/Designer's Address
Architect/Designer's E-mail Address
City I
State [ Zip F_ Telephoned
r 5. Engineer's Name
Last - First F Lic. No. F__
Engineer's Address
Engineer's E-mail Address
City
State F_ Zip F_ Telephoned
iX 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
PERMIT NO. Fez 1 - tX t 6
TYPE OF CONSTRUCTION PLAN CHECK NO. Z 8 9Z
OCCUPANCY - GROUP
PLAN CHECK FEE $ 22Z `IjU
9 267-I -064 U