HomeMy WebLinkAboutS2020-0119 - Permit ApplicationWorksheet for Fire Permit Application U
City of Newport Beach -Building DivisionPlease print 3 copies
Associated Building Permit # r Fire Sprinkler [ Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
1113 E. BALBOA BLVD;
Tenant Name OTTERBEIN RESIDENCE #Units
2. Description of Work
Use
FIRE SPRINKLERS
27 HEADS i
Last I First � Lic. No. �
Valuation $ 2 700 ;
�
Extg Sq Ft I New/Added Sq Ft F77--7Total Sq Ft j
�
- - -- —
# Stories
r New F, Add F, Alter ri Demo
State Zip Telephone
Check Appropriate Box for Applicant/Notification
rYFAMMA{r/�M
r 3. Owner s Name LastV.A,
— Firsjt —
Owner's Address
Owner's E-mail Address
City
State Zip Telephoned
4. Architect/Designer's Name
Last I First � Lic. No. �
Architect/Designer's Address
ArchitectlDesigner's E-mail Address
City
State Zip Telephone
5. Engineer's Name Last
First ( Lic. No.
Engineer's Address
Engineer's E-maB.Address
i
City
State I Zip F7777 Telephoned
r 6. Contractor's Name LastCASEY First MONTY Lic. No. 876004 Class F7
Contractor's Address
Contractor's E-mail Address
1101 KINGSTON DR
FIREPROOFMC@GMAIL.COM
City LA HA - BRA j State CA Zip 90631 Telephone 714 476 5370
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OFFICE USE ONLY
PERMIT NO. V bogtov*
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
/J �t •n ^ PLAN CHECK FEE $
-a'Lc 2a ov-i �� ``� • 11110