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Associated Building Permit#
Worksheet for Fire Permit Application eggCity of Newport Beach - Building Division
�— ri Fire Sprinkler [1 Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
TERRACE
1130 DOLPHIN
- -
- - - - -
Tenant Name ANE RESIDENCE #Units
LCO
2. Description of Work
FIRE SPRINKLERS
Use
21 HEADS
Valuation $ 2100
Extg Sq Ft I New/Added Sq Ft Total Sq Ft
-
# Stories F
Ix New rl Add r Alter � Demo
Check Appropriate Box for ApplicanVNotification
I nf�rm ��i�n
r 3.Owner's Name Last
First.
Owner's Address
Owner's E-mail Address
City -
State F-j Zip F Telephoner
(-. 4. Architect/Designer's Name Last
First F Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City __]
State F Zip F Telephoned
�j 5. Engineer's Name Last
First Lic. No.
Engineer's Address
Engineer's E-mail Address
City j
State Zip F Telephone
IX1 6. Contractor's Name Last CASEY First MONTY Lic No. 676004 Class C-16
Contractor's Address
Contractor's E-mail Address
1101 KINGSTON DR
FIREPROOFMC@GMAIL.COM
City LA HABARA
State CA Zip 90 331 Telephone 714-476-5370
OFFICE USE ONLY a� P�yO?Afi'�/Xrtsi.y� ` PERMIT NO.'N�h e�
TYPE OF CONSTRUCTION
M iiLgv 'Lv1 PLAN CHECK NO. 9t)�ji77/{7 `61 7
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OCCUPANCY - GROUP
f Y W
PLAN CHECK FEE $