HomeMy WebLinkAboutF2021-0292 - Permit Applicationzt - t41149 IN Mu�r•�
{� Worksheet for Fire Permit Application QA pt o��" �°"s`
Prir)t Folin `., 1` �, V y
City of Newport Beach - Building Division
Please print 3 copies �.;Fow
Associated Building Permit #
Fire Sprinkler [ Fire Alarm C Fire Misc
1. Project Address (Not mailing address) Floor Suite No
46 MISSION BAY11 DRIVE
Tenant Name# Units
F77
2. Description of Work
-- - -- -- ------ -
City
State F__ Zip F_ Telephone_'
Use
RESIDENTIAL
FIRE SPRINKLER SYSTEM 27 HEADS
-- ----
----- ----- ----- -------
�I
Extg Sq Ft New/Added Sq Ft r Total Sq Ft F
Valuation $ 3 200
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[X New [7Add F_Alter r; Demo
# Stories
Check Appropriate Box for Applicant/Notification
Information
F7 3. Owner's Name
Last IPE RLMAN First—
Owner's Address
Owner's E-mail Address
-- - -- -- ------ -
City
State F__ Zip F_ Telephone_'
[] 4. Architect/Designer's
Name Last First Lic. No. r
Architect/Designees Address
Architect/Designer's E-mail Address
City
State Zip Telephonel,
r 6. Engineer's Name
Last First F77777 Lic. No. —'
Engineer's Address
Engineer's E-mail Address
City
State F Zip F77777 Telephone—
r6. Contractor's Name
Last CASEY First MONTY Lic. No. 876004 Class C-16
Contractor's Address
Contractor's E-mail Address
1101 KINGSTON DRIVE
fireproofmc@gmail.com
City LA HABR-A
State CA Zip 90631 Telephone 714 476 5370
OFFICE USE ONLY PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY -GROUP
�" PLAN CHECK FEE $
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