HomeMy WebLinkAboutF2020-0247 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division F,Into _ O Lq -1
Please print 3 copies
Associated Building Permit #
1. Project Address (Not mailing address)
110 30TH ST
Tenant Name ENGSTROM RESIDENCE
2. Description of Work
RE SPRINKLERS
1 HEADS
r)-( Fire Sprinkler r, Fire Alarm FI Fire Misc
Extg Sq Ft F_! New/Added Sq Ft F_—' Total Sq Ft ,q�,
[' New r7 Add Alter ❑ Demo At®
Check Appropriate Box for ApplicanVNotification VIN
Floor Suite No
# Units F77
Use I
Valuation $ 4100
# Stories 13
F 3. Owner's Name
Last First I p`
Owner's Address
Owner's E-mail Address tz
City
State Zip Telephone
f-,'4. Architect/Designer's Name Last First F77777 Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State — Zip F—, Telephone
[. 5. Engineer's Name
Last First Lic. No.
- - -- -
Engineer's Address
Engineer's E-mail Address
City
State F Zip F77777 Telephoned
Fx 6. Contractor's Name Last CASEY First MONTY Lic. No. 876004 ClassC-76
Contractor's Address
Contractor's E-mail Address
1101 KINGSTON DR
FriRREPROOFMC@GMAIL.COM
City LA HABRA
State CA Zip 90631 - Telephone714 476 5370
OFFICE USE ONLYld%
s 4y" PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. OW r
PLAN
4
OCCUPANCY - GROUP
Graas PLAN CHECK FEE $
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