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Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
1. Project Address (Not mailing address)
41 ROYAL ST GEORGE
Tenant Name HENDERSON RESIDENCE
2. Description of Work
FIRE SPRINKLERS
55 HEADS
Extg Sq Ft F New/Added Sq Ft F
r New r Add r Alter r Demo
FX_ Fire Sprinkler r Fire Alarm r Fire Misc
%.necrc wppropnaze tsox Tor ApplicanMotification
Floor Suite No
# Units I —
Use
Valuation $ 5500
Total Sq Ft �—
# Stories I-
F 3. Owner's Name Last
FQff
Owner's Address
Owner's E-mail Address
City I
State I
Zip [— Telephoned —
F 4. Architect/Designer's Name
Last �— First [_ Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �—
Zip F_ TelephoneF_
r 5. Engineer's Name Last
First F Lic No. F__
Engineer's Address
Engineer's E-mail Address
City
State F_
Zip F_ TelephoneF_
FX 6. Contractor's Name Last CASEY
First MONTY Lic. No. 876004 Class C-16
Contractor's Address
Contractor's E-mail Address
1101 KINGSTIN DR
FIREPROOFMC@GMAIL.COM
City LA HABRA
State CA
6- 0
Zip 90631 Telephonetq a
OFFICE USE ONLY
`,�]V� PERMIT NO.
0 rfj
TYPE OF CONSTRUCTION
6)
V PLAN CHECK
OCCUPANCY - GROUP
PLAN CHECK FEE $
I vJ ✓ II -)