HomeMy WebLinkAboutX2021-3376 - Permit ApplicationSEW PO
Worksheet for Fire Permit Application o� e
nt Form City of Newport Beach - Building Division
I 7Cq-%F= NAP
Please print 3 copies
(//r .L.�2-
Associated Building Permit # x
Fire Sprinkler IJ Fire Alarm r Fire Misc
I. Project Address (Not mailing address)
Floor Suite No
1111 CLIFF DR
V
#Units
Tenant Name CONWELL RESIDENCE
I
2. Description of Work
Use i
FIRE SPRINKLERS
17 HEADS
Valuation $ 1700
Extg Sq Ft New/Added Sq Ft
Total Sq Ft
# Stories
FX New F- Add r Alter F— Demo
Check Appropriate Box for Applicant/Notification
ofinn
F 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City State F Zip F— Telephonef _�_
1 ` 4. Arch itect/Desig nor's Name Last �J
First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City �— State F_
Zip F� Telephoned
F 5. Engineer's Name Last
First Lic. No.
Engineer's Address
Engineer's E-mail Address
City �— � State F_Zip
v Telephone��
Name Last CASEY
First MONTY Lic. No. 876004 Class C-16
FX 6. Contractor's
Contractor's Address
Contractor's E-mail Address
1101 KINGSTON DR
FIREPROOFMC@GMAIL.COM
City LA HABARA State CA
Zip 90631 Telephone 714-476-5370
PERMIT NO.
OFFICE USE ONLY /�
(�
TYPE OF CONSTRUCTION
PLAN CHECK NO. G
PLAN CHECK FEE $ —
OCCUPANCY- GROUP �,