HomeMy WebLinkAboutF2019-0308 - Permit Application����� _ ®3� orksheet for Fire Permit Application 0
"Pr iit;Form '- City of Newport Beach - Building Division
Please print 3 copies (1 •� 1� f I� U IV
Associated Building Permit # l� rl F e Sprink er rl Fire Alarm (- Fire Misc
1. Project Address (Not mailing address) Floor Suite No
71 MONTECITO DR
BATNIJA RESIDENCE #Units r
Tenant Name
2. Description of Work
Zip F— Telephone,
Use �—
FIRE SPRINKLERS 60 HEADS
Architect/Designer's Address
Architect/Designer's E-mail Address
Valuation $ 6,000
Extg Sq Ft �--- New/Added Sq Ft r Total Sq Ft F_''
Zip F Telephoner
rl 5. Engineer's Name Last
First Lic. No.
# Stories (2
r', New I— Add r- Alter r Demo
Engineer's E-mail Address
Check Appropriate Box for Applicant/Notification
InFerm.�{i�n
F7,3. Owner's Name Last First F—
Owner's Address
Owner's E-mail Address
City F State F__
Zip F— Telephone,
r 4. Architect/Designer's Name Last First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F—
Zip F Telephoner
rl 5. Engineer's Name Last
First Lic. No.
Engineer's Address
Engineer's E-mail Address
City ! State F
Zip TelephoneF
F_ 6. Contractor's Name Last CASEY
First MONTY Lic No. 876004 Class C16
Contractor's Address
Contractor's E-mail Address
1101 KINGSTON DR
FIREPROOFMC@GMAIL.COM
City LA HABRA State CA
Zip 90631 Telephone 7144765370
OFFICE USE ONLY
PERMIT NO. -ice( t '
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TYPE OF CONSTRUCTION
PLAN CHECK NO. ✓
/
OCCUPANCY - GROUP
PLAN CHECK FEE $