HomeMy WebLinkAboutF2019-0115 - Permit ApplicationWorksheet for Fire Permit Application
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City of Newport Beach - Building Division 076 ?p!Q
Please print 3 copies FSO /9 -0115-
Associated
QJ/sAssociated Building Permit,Fire Sprinkler F_ Fire Alarm f— Fire Misc
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1. Project Address (Not mailing address) Floor Suite No
Last First F
624 HARBOR ISLAND DR—''
Tenant Name RIGHEIMER RESIDENCE # Units r,
Owner's E-mail Address
2. Description of Work
City
State r— —� Zip F TelephoneF�
Use
F_. 4. Architect/Designer's
FIRE SPRINKLERS (44 HEADS)
Architect/Designer's Address
Architect/Designer's E-mail Address
Valuation $ 4400.00
Extg Sq Ft F_New/Added Sq Ft F_Total Sq Ft F--•— ;
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# Stories&f
New ' Add ' Alter (— Demo
r r�
—
Check Appropriate Box for Applicant/Notification
(- 3. Owner's Name
Last First F
Owner's Address
Owner's E-mail Address
City
State r— —� Zip F TelephoneF�
F_. 4. Architect/Designer's
Name Last First F Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City �—
State w Zip [77777 Telephoned!
5. Engineer's Name
Last � First F_! Lic.
No.
Engineer's Address
Engineer's E-mail Address
City
j State Zip Telephone F77777
F_ 6. Contractor's Name
Last CASEY FirstMONTY Lic. No. 876004
Class C-16
Contractor's Address
Contractor's E-mail Address
1101 KINGSTON DR
FIREPROOFMC@GMAIL.COM
City LA HABRA
State CA Zip 90631 Telephone 714 476-5370
OFFICE USE ONLY
CJ LA." ` �C PERMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK NO.
GROUP 'i
OCCUPANCY-
PLAN CHECK FEE $
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