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Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
1. Project Address (Not mailing address)
1914 COURT ST
Tenant Name INEW RESIDENCE
2. Description of Work
r Fire Sprinkler r Fire Alarm j _ Fire Misc
(FIRE SPRINKLERS
JRQ HEADS
a;l
Extg Sq Ft F New/Added Sq Ft I Total Sq Ft
(X New r Add F- Alter [_ Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
# Units
Use
Valuation $ 2000
# Stories I3
f 3. Owner's Name
Last First
Owner's Address
Owners E-mail Address
City
State Zip F Telephone
4. Architect/Designor's
Name Last First �— Lic. No.
Architect/Designer's Address
Architect/Designees E-mail Address
City I
� State F_ Zip F_ Telephone
r 5. Engineer's Name
Last First I Lic. No. r —
Engineer's Address
Engineer's E-mail Address
City
State Zip F_ Telephoned
FX 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 iLA HABARA
State CA Zip 90631 Telephone 714-476-5370
OFFICE USE ONLY
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PERMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK N
OCCUPANCY - GROUP
PLAN CHECK FEE $