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Associated Building Permit#
Worksheet for Fire Permit Application
U
City of Newport Beach - Building Division ZO it)- 0 Z Z 3r
A
F Fire Sprinkler (— Fire Alarm r Fire Misc 'dole 44
1. Project Address (Not mailing address) Floor Suite No
117 Jade Avenue Newport Beach, CA 92662 F_
Tenant Name # Units �-
Owner's E-mail Address
2. Description of Work
Use SFR
Design/build a 3 -stories RESIDENTIAL fire sprinkler system as per 2016 NFPA 13D - (31) heads.
State CA Zip 92662 Telephone (818) 262-3473
Valuation $ 5,200
Extg Sq Ft �` New/Added Sq Ft 4,031 Total Sq Ft 4,031
Architect/Designer's Address
Architect/Designer's E-mail Address
#Stories
(X New (— Alter � Demo
F_ Add
Ix 5. Engineer's Name
Check Appropriate Box for Applicant/Notification
FT 3. Owner's Name
Last Skelly First Tim
Owner's Address
Owner's E-mail Address
117 Jade Avenue
City Newport Beach
State CA Zip 92662 Telephone (818) 262-3473
F 4. Arch itect/Designer's
Name Last �, First I Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City �
State F_,. Zip F_ Telephoner
Ix 5. Engineer's Name
Last Vu First 9559 Nightingale Lic. No. 1038755
Engineer's Address
Engineer's E-mail Address
9559 Nightingale Avenue
ifireprotectionsales@gmaiLcom
City Fountain Valley
State CA Zip 92806 Telephone (714) 231-5108
FT 6. Contractor's Name
Last Vu First Anthony Lic. No. 1038755, ! Class Fi6
Contractor's Address
Contractor's E-mail Address
9559 Nightingale Avenue
ifireprotectionsales@gmaiLcom
City Fountain Valley
State CA Zip 92806 Telephone (714) 231-5108
OFFICE USE ONLY
PERMIT NO. W a D
n/1p�
CHECK NO. 0011AInto
TYPE OF CONSTRUCTION
PLAN
OCCUPANCY- GROUPD
M PLAN CHECK FEE $