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City of Newport Beach Fire Permit Application tlr�
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1
Project Address
7 HERMITAGE LANE / VALUATION: $3900
Number and Street suite/unit zip
Associated Building Permit #
Z
Own er/Tenant
KHOURY RESIDENCE
Name
3
Scope of work/
INSTALL 39 HEADS AND 1 SYSTEM RISER
misc. description
Cons ruction Ti Addition Alteration Demolition
*Check one
Commercial Fire Sprinkler
Number of Stories per
39 Number of FS Heads 1 buildin
1-1 13 13R ✓ I 13D
Multi-Family(3+units) I I Fi re Alarm
r--j Number of FA Devices 0 Number of Dwelling
Units
Y I Residential (1-2 units) ElFire Underground
1O Number of Risers
*Check one Fire Misc.
*write in accurate count
*describe above
4 Applicant Information Name: MONTY CASEY
Address: 1101 KINGSTON DR, LA HABRA CA 90631
Phone#: 714-476-5370 Email: FIREPROOFMC(d).GMAII
m Check if same as Contractor
Designer Information Name:
Address:
Phone#: Email:
®Check if same as Contractor
Contractor Information Name:
Address:
Phone#: Email:
License#: Class:
Office Use Permit Plan Check Permit/Plan
Number Number Check Fee $