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Associated Building Permit #
Worksheet for Fire Permit Application o NEwroRe
City of Newport Beach - Building Division
fu Z2 __0 0(0;;
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9C/FO RNP
fX Fire Sprinkler f`" Fire Alarm f_ Fire Misc
1. Project Address (Not mailing address)
1115ESSEX LANE
Tenant Name ILAUER RESIDENCE
2. Description of Work
(FIRE SPRINKLERS
`, i HEADS
Extg Sq Ft r-_ New/Added Sq Ft F
Total Sq Ft
R New F Add F Alter
F Demo
Check Appropriate Box for Applicant/Notification
Infnvw .,a:.,,,
F 3. Owner's Name Last
Owner's Address First
Owner's E-mail Address
Floor Suite NO
#Units 1_�
Use
Valuation $
-1
# Stories F7
city
State F_ Zip F Telephoner----
F 4. Arch itect/Designer's Name Last �—
First Lic. No. Architect/Designer's Address
Architect/Designer's E-mail Address
City I State I V
Zip Telephone['
r- 5. Engineer's Name Last F_--- ---
FirstF__-
Engineer's Address Lic. No.
Engineer's E-mail Address
City F
State �— Zip �, Telephoner__�
Cx 6. Contractor's Name Last CASEY ---
c. No. MONTY Li876004
Contractor's Address First Class C-16
1101 KINGSTON DR Contractor's E-mail Address
FIREPROOFMC@GMAIL.COM
City LA HABARA State CA
Zip �0631 Telephone 714-476-5370
OFFICE USE ONLY
TYPE OF CONSTRUCTION PERMIT NO.
OCCUPANCY - GROUP PLAN CHECK NO. b'>'yl �zY
hi ,t v PLAN CHECK FEE $
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