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Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
1. Project Address (Not mailing address)
216 SAPPHIRE AVE
Tenant Name PERR RESIDENCE
2. Description of Work
FIRE SPRINKLERS
27 HEADS
Extg Sq Ft F — - New/Added Sq Ft F
FX New F_ Add r Alter r Demo
(K Fire Sprinkler F— Fire Alarm F— Fire Misc
trr lc Appropriate box for Applicant/Notification
Floor Suite No
# Units �—
Use
Valuation $ 2700
Total Sq Ft �—
# Stories ra—
F 3. Owner's Name Last
First F—
Owner's Address
Owner's E-mail Address
City
State �—
Zip �— Telephoned
r 4. Architect/Designer's Name
Last
First F— Lic. No. F—
Architect/Designer's Address
Architect/Designees E-mail Address
City
State �—
Zip F— Telephoner
F 5. Engineer's Name Last
Firstr—Lic. No. F_
Engineer's Address
Engineer's E-mail Address
City
State F_
Zip [_ TelephoneF�®
rX 6. Contractor's Name Last CASEY
First MONTY Lic. No. 776004 Class C-16
Contractor's Address
Contractor's E-mail Address
F01 KINGSTON DR
FIREPROOFMC@GMAIL.COM
City ILA HABRA
State CA
Zip 9FO631 Telephone 714-476-5370
OFFICE USE ONLY
w&z „
CV �N PERMIT NO.
l/
TYPE OF CONSTRUCTION
PLAN CHECK NO. c/
OCCUPANCY - GROUP
X2j mot . C)
(3'�,) PLAN CHECK FEE $