HomeMy WebLinkAboutF2021-0519 - Permit Application (3)Worksheet for Fire Permit Application
Print Form � °
City of Newport Beach - Building Division ���
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Please print 3 copies ORS P
Associated Building Permit # (X Fire Sprinkler (v Fire Alarm Fire Misc
1. Project Address (Not mailing address) Floor Suite No
317 APOLENA AVE F�-�y"� _
Tenant Name NEW RESIDENCE # Units F_-W�
2. Description of Work
�FIRE SPRINKLERS Use U
27 HEADS - - -
Valuation $ 2700
Extg Sq Ft New/Added Sq Ft Total Sq Ft -
r
# Stories F
r New F- Add F-Afterr Demo
Check Appropriate Box for Applicant/Notification
F 3. Owner's Name
Last
First
Owner's Address
Owner's E-mail Address
City
State
Zip Telephone)
F 4. Architect/Designer's
Name Last
First
Lic. No.
Arch itect/Designer's Address
Architect/Designer's E-mail Address
City
State
Zip Telephone
F 5. Engineer's Name
Last
First
Lic. No.
Engineer's Address
E-mail Address
(�Engineer's
I
city
State F
Zip Fp Tele hone
F 6. Contractor's Name
Last IASEY First MONTY Lic. No. I876004
Class C-16
Contractor's Address
Contractor's E-mail Address
1101 KINGSTON DR
FIREPROOFMC@GMAIL.COM
City LA HABRA
State CA
Zip 990631 Telephone 714-476-5370
OFFICE USE ONLY
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PERMIT NO.
TYPE OF CONSTRUCTION O(�,{� /�
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�b� � � PLAN CHECK NO.
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OCCUPANCY- GROUP
_ PLAN CHECK FEE $'
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