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Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Associated Building Permit #
FX_ Fire Sprinkler F_ Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
2610 BASSWOOD ST�—
Tenant Name GILDEN RESIDENCE REMODEL # Units F-
2. Description of Work
Use
FIRE SPRINKLERS
26 HEADS
Valuation $ 2600
Extg Sq Ft New/Added Sq Ft Total Sq Ft �—
# Stories
r New r Add � Alter r Demo
Check Appropriate Box for Applicant/Notification
r 3. Owner's Name Last
4� i 1*AA First A —
Owner's Address
Owner's E-mail Address
City
State 7— Zip F— Telephone
r 4. Architect/Designer's Name
Last First Lic. No.
�—
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F_ Zip F_ Telephoned
r 5. Engineer's Name Last
First 7— Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State F_ Zip F— Telephoner
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
State CA Zip 00631 Telephone 714 476-5,3 070
OFFICE USE ONLY
^p A PERMIT NO. 1 qA"-
(N(�
3
TYPE OF CONSTRUCTION
PLAN CHECK NO. IJI$ '
U
OCCUPANCY - GROUP
X VlI w� (�'� PLAN CHECK FEE $
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