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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)
1027 W BAY AVE a-e
Tenant Name BAY RESIDENCE
2. Description of Work
FIRE SPRINKLERS
58 HEADS
Extg Sq Ft New/Added Sq Ft F__ Total Sq Ft
r New r" Add r- Alter r- Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
# Units
Use
Valuation $ 5,800
# Stories 1
F_ 3. Owner's Name
Last First �—
Owner's Address
Owner's E-mail Address
City
State F_Zip r Telephoned
F- 4. ArchitectlDesigner's Name Last ir First I Lic. No.
Architect/Designer's Address
ArchitectlDesigner's E-mail Address
City
State �— Zip I Telephone
r- 5. Engineer's Name
Last First F_ Lic. No. F_
Engineer's Address
Engineers E-mail Address
City
State F— Zip F_ TelephoneF_
rX 6. Contractor's Name
Last CASEY First MONTY Lic. No. 876004 Class C-16
Contractors Address
Contractors E-mail Address
i1101 KINGSTON DR
FIREPROOFMC@GMAIL.COM
City LA HABARA
State CA Zip 90631 Telephone 714-47766-5370
PERMIT NO.
OFFICE USE ONLY
PLAN CHECK
TYPE OF CONSTRUCTION
OCCUPANCY- GROUP
PLAN CHECK FEE $