HomeMy WebLinkAboutF2021-0632 - Permit ApplicationWorksheet for Fire Permit Appli tion
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City of Newport Beach -Building Divisio��
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Associated Building Permit # Fx-! Fire Sprinkler F_ Fire Alarm r- Fire Misc
1. Project Address (Not mailing address) F� i
1521 DOROTHY LANE
Tenant Name McCOLLUM RESIDENCE # Units
2. Description of Work
Use
FIRE SPRINKLERS
31 HEADS
Valuation $ 3100
Extg Sq Ft New/Added Sq Ft Total Sq Ft
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#Stories i
(XI New r Add F- Alter r Demo
Check Appropriate Box for Applicant/Notification
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3. Owner's Name Last First
Owner's Address Owner's E-mail Address
City F _ State F Zip F TelephoneF�
r 4. Architect/Designer's Name Last First Lic. No. �—
ArchitecUDesigner's Address Architect/Designer's E-mail Address
City State F_ Zip F— Telephoned
F 5. Engineer's Name Last First F Lic. No.
Engineer's Address Engineer's E-mail Address
City State F_ Zip F Telephone
r! 6. Contractor's Name Last CASEY First FMONTY Lic. No. 876004 Class C-16
Contractor's Address Contractor's E-mail Address
1101 KINGSTON DR FIREPROOFMC@GMAIL.COM
City LA HABARA State CA Zip 90631 Telephone F714476-5370 -
OFFICE USE ONLY X-1 02A v(0 S!,>
!,(� PERMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY - GROUP �'t D2� (gull PLAN CHECK FEE $