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Please print 3 copies
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
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Associated Building Permit #
r Fire Sprinkler F_ Fire Alarm
r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
5009 SEASHORE DR i ` - I
Tenant Name S$,EASHORE LLC # Units F—
2. Description of Work
FIRE SPRINKLERS Use
121 HEADS
Valuation $ 21
Extg Sq Ft New/Added Sq Ft Total Sq Ft
# Stories I
FX New F_ Add F_ Alter F— Demo
Check Appropriate Box for Applicant/Notification
F 3. Owner's Name
Last
First
Owner's Address
Owner's E-mail Address
city
State - W�
Zip Telephone)
(` 4. Architect/Designer's
Name Last First Lic. No. I`u-
Architect/Designer's Address
Architect/Designer's E-mail Address
City I
State �®
Zip I r Telephonel
j` 5. Engineer's Name
Last
First FLic. No. �Y
Engineer's Address
Engineer's E-mail Address
City r�
State
Zip Telephone)
FX 6. Contractor's Name
Last CASEY First MONTY 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 714-476-5370
OFFICE USE ONLY
PERMIT NO. 0 d qQ
TYPE OF CONSTRUCTION
PLAN CHECK NO. oN 6 3 -Zp 2.2
OCCUPANCY - GROUP
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PLAN CHECK FEE $
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