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Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
1. Project Address (Not mailing address)
423 SAN BERNADINO AVE
Tenant Name WERNER RESIDENCE
2. Description of Work
FIRE SPRINKLERS
49 HEADS
FXX' Fire Sprinkler r Fire Alarm r Fire Misc
Extg Sq Ft F— New/Added Sq Ft F Total Sq Ft
r New r Add F_ Alter F Demo
L;necK Appropriate Box for Applicant/Notification
Floor Suite No
# Units I
Use
Valuation $ 4900
# Stories I3
F_ 3.Owner's Name Last
FirstF—
Owner's Address
Owner's E-mail Address
City F_
State 7—
Zip F— Telephoned
F 4. Arch itecUDesigner's Name Last
r
First F_ Lic. No.l
Architect/Designer's Address
Architect/Designees E-mail Address
City I
State F_
Zip I Telephone—
r 5. Engineer's Name Last
First 7— Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State F_—
Zip F Telephone—
r 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 HABARA
State CA
Zip 90631 Telephone 714-476-5370
OFFICE USE ONLY
PERMIT NO. F20? 7- 045
TYPE OF CONSTRUCTION
PLAN CHECK NO. r C?-OZZ r 21 LC
OCCUPANCY- GROUP
PLAN CHECK FEE $