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Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
rX Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tremont Lane�—
4527
Tenant Name # Units F
2. Description of Work
Use I[
NFPA 13D Fire Sprinkler System
Valuation $ 14,850
Extg Sq Ft F New/Added Sq Ft �— Total Sq Ft 9,852
-1-1 1-rec4cAz
#Stories
fx New r Add r- Alter r Demo
Check Appropriate Box for Applicant/Notification
Infnrmnfi^n
r 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City �
State F_ Zip F Telephoned
r 4. Architect/Designer's Name
Last Gutierrez First Rubi Lic. No. r
Architect/Designer's Address
Architect/Designers E-mail Address
8085 E. Crystal Dr.
RubiG@resfire.com
City Anaheim
State CA Zip 92807 Telephone (714)666-8450
(W 5. Engineer's Name Last
- First— Lic. No.
Engineer's Address
Engineer's E-mail Address
City I
State I Zip �— TelephoneF
(X 6. Contractor's Name Last residential Fire Systems First F Lic. No. 786965 Class C-16
Contractor's Address
Contractors E-mail Address
8085 E. Crystal Dr.
engineering@resfire.com
City Anaheim State CA Zip 92807 Telephone (714)666-8450
OFFICE USE ONLY
� PERMIT NO.
TYPE OF CONSTRUCTION
/)
�,y PLAN CHECK NO.
OCCUPANCY - GROUP
Y
( PLAN CHECK FEE $