HomeMy WebLinkAboutF2019-0236 - Permit ApplicationWorksheet for Fire Permit Application
print Form „fr DI�
° �22�City of Newport Beach -Building Division
Please print 3 copies J
Associated Building Permit # FX- Sprinkler r Fire Alarm j-', Fire Misc
1. Project Address (Not mailing address) Floor Suite No
75 TORREY PINES
DAO RESIDENCE # Units
Tenant Name I F77
2. Description of Work
Use
State Zip Telephone'
FIRE SPRINKLERS 40HEAD5---
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Extg Sq Ft New/Added Sq Ft F Total Sq Ft F77777--�
Valuation $ 4000.00
City
# Stories
F
rX, New �: Add r Alter n Demo
FirstF77777 Lic No.
Check Appropriate Box for Applicant/Notification
Infnrmmfinn
F_ . 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City
State Zip Telephone'
F_ 4. Architect/Designer's Name Last
First F77 Lic. No.—j
Architect/Designer's Address
Architect/Designees E-mail Address
City
State Zip Telephonel—
F_! 5. Engineer's Name Last
FirstF77777 Lic No.
Engineer's Address
Engineer's E-mail Address
City
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State �— Zip F Telephone
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r! 6. Contractor's Name Last CASEY
First MONTY Lic No. 876004 Class C-16
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Contractor's Address
Contractor's E-mail Address
1101 KINGSTON DR
FIREPROOFMC@GMAIL.COM
Cit LA HABRA
State CA Zi 90631— Telephone 714-476-5370
OFFICE USE ONLY
i 0 • �� PERMIT NO. • 02 3le:�7
TYPE OF CONSTRUCTION
,to PLAN CHECK NO.�
OCCUPANCY- GROUP
t id PLAN CHECK FEE $