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Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application F1021 _ o4m
City of Newport Beach - Building Division �,��
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1. Project Address (Not mailing address)
3730 BLUE KEY
Tenant Name STORM RESIDENCE
2. Description of Work
FIRE SPRINKLERS
57 HEADS
Extg Sq Ft I— New/Added Sq Ft
Fx New F- Add F— Alter F— Demo
Fx Fire Sprinkler F— Fire Alarm F- Fire Misc
Check Appropriate Box for Applicant/Notification
Floor Suite No
# Units
Use
Valuation $ 5700
Total Sq Ft
# Stories F
F 3. Owner's Name Last
First F
Owner's Address
Owner's E-mail Address
City
State F_ Zip F_ Telephoned_-
F 4. Architect/Designer's Name Last
First Lic. No.
Architect/Designer's Address
Architect/Designers E-mail Address
City
State F Zip F_ Telephoned
F 5. Engineer's Name Last
FirstF Lic. No. �®
Engineer's Address
Engineers E-mail Address
City
State F_—zip F_ Telephoned
Fx 6. Contractor's Name Last CASEY
First MONTY Lic. No. 876004 class c-16
Contractor's Address
Contractors E-mail Address
1101 KINGSTON DR
FIREPROOFMC@GMAIL.COM
City LA HABRA
State CA Zip 9F0631 Telephone 714-476-5370
OFFICE USE 0
NLY
tonT
/
TYPE OF CONSTRUCTION /
OCCUPANCY- GROUP
Z PLAN CHEOCK NO1(41
PLAN CHECK FEE
jf $