HomeMy WebLinkAboutF2020-0504 - Permit ApplicationPrint Form
Please print 3 copies
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
um
Associated Building Permit #
FX_ Fire Sprinkler F_ Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
Floor
Suite No
1417 EAST BAY
r
Tenant Name EAST BAY MANOR
r\ 1 # Units
V�
2. Description of Work
FIRE SPRINKLERS
Use
63 HEADS
Valuation $
6300
Extg Sq Ft F_ New/Added Sq Ft F- Total Sq Ft
#Stories F
FX New F_ Add F_ Alter F_ Demo
Check Appropriate Box for Applicant/Notification
Information
WdA
F_ 3. Owner's Name Last
First F_
Owner's Address
Owner's E-mail Address
City
State F_ Zip F Telephoned
r 4. Architect/Designer's Name
Last First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State Zip F Telephoned
r 5. Engineer's Name Last
First F Lic. No. r�
Engineer's Address
Engineer's E-mail Address
City
State F_ Zip r_ Telephoned
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 HABRA
State CA Zip g0631 Telephone 714-476-5370
OFFICE USE ONLY
XZoZ_0 l 02, PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. £ -
OCCUPANCY - GROUP
�� G2Z PLAN CHECK FEE $
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