HomeMy WebLinkAboutF2019-0371 - Permit ApplicationWorksheet for Fire Permit Application
'PGint Foirtt; _ City of Newport Beach - Building Division
Please print 3 copies �V I07
I 1
Associated Building Permit # FX- Sprinkler F_ Fire Alarm F-, Fire Misc
SEW PCR
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94[o0.N�r
1. Project Address (Not mailing address) Floor Suite No
428 62ND ST
Tenant Name CHICCA RESIDENCE # Units
2. Description of Work
FIRE SPRINKLERS
Use
33 HEADS
i
Zip [7777 Telephone J
—
Valuation $ 3300.00
Extg Sq Ft F New/Added Sq Ft F Total Sq Ft F-7777
Architect/Designees Address
#Stories
)<', New 17 Add j- Alter j- Demo
StateF7 '
Check Appropriate Box for Applicant/Notification
(- 3. Owner's Name Last
First F77777
Owner's Address
Owner's E-mail Address
City
State F—
i
Zip [7777 Telephone J
C 4. ArchitecUDesigner's Name Last
J First Lic. No. �I
Architect/Designees Address
ArchitecUDesigner's E-mail Address
I
City
StateF7 '
Zip �� TelephoneF_ _
i7 5. Engineer's Name Last
First F Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State �—
Zip Telephone!
X16. Contractor's Name Last CASEY
First MONTY Lic. No. 876004 Class C-16 _ I
Contractor's Address
Contractor's E-mail Address
1101 KINGSTON DR
FIREPROOFMC@GMAIL.COM
City LA HABRA
StateCA
Zip 90631 Telephone 714-476-5370
OFFICE USE ONLY
I Z� 1 PERMIT NO. f �/-
TYPE OF CONSTRUCTION
OCCUPANCY - GROUP
` (
J r� � -
\ / LAN CHECK NO. p��i
Xut TI 7�LAN CHECK FEE $ �� (` 0�� I