HomeMy WebLinkAboutF2023-0091 - Permit ApplicationWorksheet for Fire Permit Application sliew—,��nt Forrt;; ` City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # )< Fire Sprinkler Fire Alarm p j— (— Fire Misc
1. Project Address (Not mailing address)
1015 DOLPHIN TERRACE
Tenant Name POLOS RESIDENCE
2. Description of Work
FIRE SPRINKLERS
44 HEADS
Extg Sq Ft F New/Added Sq Ft F Total Sq Ft
r New F_ Add r Alter r Demo
%,necK appropriate ttox Tor Applicant/Notification
_t-----L° - --
Floor
Suite No
# Units
F
Use
Valuation $ 4400
# Stories I1
r 3.Owner's Name Last
FirstF__
Owner's Address
Owner's E-mail Address
City
State �
ZIPF Telephone
r 4. Arch itect/Designer's Name
Last
First F_ Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F_
Zip F Telephone—
r 5. Engineer's Name Last
First F_ Lic. No. F_—
Engineer's Address
Engineer's E-mail Address
City
State �—
Zip �— Telephone—
r 6. Contractor's Name Last CASEY First MONTY Lic. No. 876004 Class C-16
Contractor's Address
Contractor's E-mail Address
1101 KINGSTON DR
FIREPROOFMC@GMAIL.COM
City LA HABARA
State CA
Zip 90631 Telephone 714-476-5370
OFFICE USE ONLY
PERMIT NO. F Z023 _ �(1GL
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $