HomeMy WebLinkAboutF2019-0627 - Permit ApplicationWorksheet for Fire Permit Application NG:•;Fotm, 'City of Newport Beach - Building DivisionZ011 - t)bG1
Please print 3 copies
Associated Building Permit #[', Fire Sprinkler rj Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
eF77 F777
- - -- -
Tenant Name $Erews Residence i #Units
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2. Description of Work
Use
Fire sprinklers
79-laeads
Owner's E-mail Address
Valuation $I!
Extg Sq Ft F�New/Added Sq Ft Total Sq Ft
Zip L Telephone
r 4. Architect/Designer's Name Last
# Stories
>( New r Add[ Alter r Demo
Check Appropriate Box for Applicant/Notification
Inf~Mm Nnn
F7 3. Owner's Name Last
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First_
Owner's Address
Owner's E-mail Address
City
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State�-
Zip L Telephone
r 4. Architect/Designer's Name Last
— - - - FirstF-7 _7777 Lic. No. �I
Architect/Designer's Address
Architect/Designees E-mail Address
City
J
State
Zip 1 Telephoned I
S. Engineer's Name Last
j First C Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State ��il
Zip Fi Telephone��
iX; 6. Contractor's Name Last Casey
First Mon — _ _ Lic. No. 876004 Class c-16
Contractor's Address
Contractor's E-mail Address
1101 Kingston Dr
fireproofmc@gmail,com
City La Habra j
State CA
Zip90631 Telephone 714-4765370
OFFICE USE ONLY
r _ PERMIT NO.
TYPE OF CONSTRUCTION
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` PLAN CHECK NO. �C •xa��
OCCUPANCY- GROUP
�� PLAN CHECK FEE $
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