HomeMy WebLinkAboutF2020-0321 - Permit ApplicationPr',;nt Form
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division 'Z�AJ,7rnnfl
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Fire Sprinkler F, Fire Alarm r, Fire Misc
Suite No
1. Project Address (Not mailing address) Floor Suite
1404 E. BALBOA BLVD
Units
SHUMWAY RESIDENCE
Tenant Name
2. Description of Work
Use
FIRE SPRINKLERS
--- - - - -
23 HEADS
Valuation $ 2300
Extg Sq Ft �, New/Added Sq Ft Total Sq Ft �,
- - - -
# Stories 2
7
n New f7 Add r Alter F_ Demo
.
Check Appropriate Box for ApplicantMotification
r-,,'3. Owner's Name Last First
Owner's Address Owner's E-mail Address
City --'ivw12 L� - ] State TL, ZipOKTelephone F',
I
F- 4. Architect/Designer's Name Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F77 Zip Telephone—'
[-]' S. Engineer's Name Last First F77777 Lic. No.
Engineer's Address Engineer's E-mail Address
--- - -- -- i - - i - --- - - -_ _ -- ---- _ ,
City State r t _ . Zip � Telephoned'
[j 6. Contractor's Name Last CASEY First[MO, Lic. No. 676004 Class C-16
Contractor's Address Contractor's E-mail Address
1101 KINGSTON DR - FIREPROOFMC@GMAIL.COM
City LA HABRA State CA - -, Zip 90631 Telephone 714-476-5370
OFFICE USE ONLY PERMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK NO. t
OCCUPANCY- GROUP PLAN CHECK FEE $