HomeMy WebLinkAboutF2019-0070 - Permit ApplicationWorksheet for Fire Permit Application
- P,rirt.Form City of Newport Beach -Building Division
Please print 3 copies �%0 � � � � D
Associated Building Permit #
rx-, Fire Sprinkler F Fire Alarm F_ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
1100 EBBTIDE
# Units
Tenant Name HANSEN REMODEL
2. Description of Work
Use
FIRE SPRINKLERS 12 HEADS
_
-..--0-
Valuation $ 1200.00
Extg Sq Ft F_New/Added Sq Ft F-' Total Sq Ft r,,
ArchitecUDesigner's E-mail Address
# Stories 2
['
F- New f-, Add r Alter r Demo
Check Appropriate Box for Applicant/Notification
F- 3. Owner's Name Last
First
Owner's Address
Owners E-mail Address
State �— Zip F Telephone—
r 4. Architect/Designer's Name Last
First Lic. No. F
Architect/Designers Address
ArchitecUDesigner's E-mail Address
City
State Zip Telephone
r 5. Engineer's Name Last[____ First Lic No.
Engineer's Address
Engineers E-mail Address
City F7 - -
State �— Zip F777TelephoneF77777
[-', 6. Contractor's Name Last CASEY - First MONTY Lic. No. 876004
Class C-16
Contractors Address
Contractors E-mail Address
1101 KINGSTON DR
FIREPROOFMC@GMAIL .COM
City LA HABRA
_ Zip 531 - Telephone 714 476-5370
State CA 90
OFFICE USE ONLY
1 PERMIT NO.
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TYPE OF CONSTRUCTION��
PLAN CHECK NO.
AAi i4;1
OCCUPANCY -GROUP
PLAN CHECK FEE $
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