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Associated Building Permit#
Worksheet for Fire Permit Application O�EwPy@
Ci of Newport Beach -Building Division
sell F.20d4-0076
oP F �=s
MCIFX Fire Sprinkler r Fire Alarm Fire Misc
1. Project Address (Not mailing address) Floor Suite No
204 COLLINS AVE
Tenant Name NEW RESIDENCE # Units F,
2. Description of Work
_
Use
Owner's E-mail Address
FIRE SPRINKLERS 24 HEADS
e
State F__-
Extg Sq Ft [_New/Added Sq FtF Total Sq Ft �—j
Valuation $ 2400.00
- -
Name Last First —', Lic. No.
# Stories
[7New r, Add r Alter r Demo
-
Check Appropriate Box for Applicant(Notification
InF�rw.�4'r.n
F_ 3. Owner's Name
Last
First
Owner's Address
Owner's E-mail Address
City
e
State F__-
Zip F— TelephoneF_
r- 4. Architect/Designer's
Name Last First —', Lic. No.
Architect/Desi ner's Address
9
Architect/Designer's E-mail Address
City
State
Zip F77 Telephoned
FI 5. Engineer's Name
Last �—
First[ -7777777 Lic No.
Engineer's Address
Engineer's E-mail Address
City �—
State F—
Zip F Telephone��
F76. 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 117A HABRA
State CA
Zip 90631 Telephone714-476-5370
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. G
OCCUPANCY -GROUP
IZA I
PLAN CHECK FEE $