HomeMy WebLinkAboutF2019-0291 - Permit ApplicationWorksheet for Fire Permit Application
-P�nt Form.- City of Newport Beach - Building Division
Please print 3 copies -b•-LO 1
Associated Building Permit # FX_ Sprinkler r Fire Alarm
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F_ Fire fld�ll /� I ��,�fl ✓ IJ
1. Project Address (Not mailing address) Floor Suite No
5312 RIVER AVE—,
Tenant Name PORTEOUSRESIDENCE #Units �-
Owner's Address
2. Description of Work
—
City
Use
FIRE SPRINKLERS 36 HEADS
r' 4. Architect/Designees Name
Last
Valuation $ 3600
Extg Sq Ft [_New/Added Sq Ft F----- Total Sq Ft F_'
ArchitectlDesigner's E-mail Address
# Stories l
FR New r Add r Alter r Demo
Zip F TelephoneF
Check Appropriate Box for Applicant/Notification
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r 3. Owner's Name Last l
First F
Owner's Address
Owner's E-mail Address
City
State F
Zip F TelephoneF�
r' 4. Architect/Designees Name
Last
First Lic. No.
Architect/Designer's Address
ArchitectlDesigner's E-mail Address
City F__
State F
Zip F TelephoneF
r 5. Engineer's Name Last
First F Lic. No.
Engineer's Address
Engineer's E-mail Address
City
StateZip
Telephoned
r_: 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 HABRA
State CA
Zip 90631 Telephone(714-4765370
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $