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Associated Building Permit #
Worksheet for Fire Permit Application U%,`11
City of Newport Beach - Building Division
r Fire Sprinkler r Fire Alarm 7 Fire Misc
1. Project Address (Not mailing address) Floor Suite No
1831 NEWPORT HILLS DRIVE F— �—
Tenant Name # Units F—
r'r
2. Description of Work li
INSTALLATION OF OF A RESIDENTIAL FIRE SPRINKLER SYSTEM HE DS Use
Valuation $ 5200
Extg Sq Ft F New/Added Sq Ft � Totat Sq
5
X New F_ Add [— Alter r- Demo
Check Appropriate Box for Applicant/Notification
F 3. Owner's Name Last
First F
Owner's Address
Owner's E-mail Address
City F
State F__ Zip F Telephone7—
F 4. Architect/Designer's Name
Last First Lic. No. F
Architect/Designers Address
Architecl/Designers E-mail Address
City �
State F_ Zip F Telephoned
F 5. Engineer's Name Last
�— First F Lic No. F_
Engineer's Address
Engineers E-mail Address
City
State Zip Telephone
r 6. Contractor's Name Last CASEY First MONTY Lic No. 876004 Class C-16
Contractors Address
Contractors E-mail Address
1101 KINGSTON DRIVE
fireproofmc@gmail.com
City LA HABRA
State CA Zip 9FO631 Telephone 714 476 5370
OFFICE USE ONLY
Lvl, �PERMIT NO. LL)--r
TYPE OF CONSTRUCTION
PLAN CHECK NO. ✓ `
OCCUPANCY - GROUP
t" 1 PLAN CHECK FEE $