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Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
iX Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
616 POINSETTIA AVE
Tenant Name NEW DUPLEX
# Units F
2. Description of Work
FIRE SPRINKLERS iv Use . L_
35 HEADS CIL
Valuation $ 3500
Extg Sq Ft �— New/Added Sq Ft F Total Sq Ft
# Stories
New � Add (— Alter j- Demo
Check Appropriate Box for Applicant/Notification
F 3. Owner's Name Last
First F__
Owner's Address
Owner's E-mail Address
City I
State F_
Zip F Telephoned
r 4. Architect/Designer's Name
Last
First F_ Lic.
No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F—
Zip F Telephoned
r 6. Engineer's Name Last
First F— Lic. No. �®_®
Engineer's Address
Engineer's E-mail Address
City
State F_
Zip r_ Telephoned
6. Contractor's Name Last CASEY
First MONTY Lic. No. 876004
Class C-16
Contractor's Address
Contractor's E-mail Address
1101 kKNGSTON DR
FIREPROOFMC@GMAIL.COM
City LA HABRA
State CA
Zip 90631 Telephone 714-476-5370&t'—1
�J
OFFICE USE ONLY
3
t�
PERMIT NO.
TYPE OF CONSTRUCTION
- PLAN CHECK NO.
I 0
J
OCCUPANCY -GROUP
PLAN CHECK FEE $
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