HomeMy WebLinkAboutF2020-0427 - Permit ApplicationWorksheet for Fire Permit Application
Ptjnt Form-.u`'
City of Newport Beach -Building Division
pease print 3 copies PIN I1 i O � �f T
Associated Building Permit # rl Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
JASINE AVE
Tenant Name MILLER RESIDENCE
2. Description of Work
E SPRINKLERS
HEAD
Extg Sq Ft � New/Added Sq Ft F! Total Sq Ft
New r, Add r Alter r Demo
Check Appropriate Box for Applicant/Notification
UF1
Floor Suite No
F77
# Units 177
Valuation $ 28W
# Stories I
3.Owner's Name
Last First
Owner's Address
Owner's E-mail Address
I
City
_ - State Zip - Telephone -- .
r' 4. ArchitecVDesigner's
Name Last _I First - - j Lic. No.
--
Architect/Designer's Address
_
Architect/Designer's E-mail Address
City -
- State Zip l Telephoned,
5. Engineer's Name
Last First [777777 Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State Zip li Telephoned
FX-16. Contractor's Name
Last CASEY - First FONTY - Lic. No. C t6 , Class 876004
Contractor's Address
Contractor's E-mail Address
1101 KINGSTON DR
FIREPROOFMC@GMAIL.COM
City LA HABRA -
State CA Zip 90631 Telephone 714 476-53702'Z(�1
OFFICE USE ONLY�( 111 PERMIT NO. V
TYPE
OF CONSTRUCTION.
OCCUPANCY -GROUP
PLAN CHECK NO.
&\is�� �(� PLAN CHECK FEE
$