HomeMy WebLinkAboutF2021-0094 - Permit Application;print Forme„'
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application �� 6WPpR m
City of Newport Beach - Building DivisionMO`00,4
NSP
r, Fire Sprinkler Fire Alarm [, Fire Misc
1. Project Address (Not mailing address) Floor Suite No
1200 W. OCEANFRONT I
Tenant Name SHAH RESIDENCE # Units
Owner's E-mail Address
2. Description of Work
Zip �I Telephone
F777
FIRE SPRINKLERS
Use
42 HEADS i
-
Architect/Designer's Address
Valuation $ 4200
Extg Sq Ft �, New/Added Sq Ft Total Sq Ft
- -----
5. Engineer's Name
# Stories 2
r New r7 Add Alter r Demo
Engineer's E-mail Address
Check Appropriate Box for Applicant/Notification
r,
3. Owner's Name
Last si{/ - First ,
Owner's Address
Owner's E-mail Address
CityState
Zip �I Telephone
F777
(' 4. Architect/Designer's
Name Last - First Lic. No. —j
Architect/Designer's Address
Architect/Designer's E-mail Address
City
-- --
StateF777 Zip I Telephone
- - -
5. Engineer's Name
Last - - --- First Lic, No.
Engineer's Address
Engineer's E-mail Address
J
City i 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 HABRA
i State CA Zip 90631 Telephone 714-476-5370
OFFICE USE ONLY
t1 PERMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK NO. b�J A0 1.4
OCCUPANCY - GROUP
/
l� _ , PLAN CHECK FEE $
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