HomeMy WebLinkAboutF2023-0015 - Permit ApplicationWorksheet for Fire Permit Application a
Print Form City of Newport Beach - Building DivisionPlease print 3 copies
el
Associated Building Permit # � r Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
1211 PORTSIDE WAY F �—
Tenant Name MARTIN RESIDENCE
2. Description of Work
FIRE SPRINKLERS
37 HEADS
Extg Sq Ft F— New/Added Sq Ft I— Total Sq Ft
# Units
Use
Valuation $ 3700
IX New i— Add r Alter r Demo I # Stories I
Check Appropriate Box for Applicant/Notification
F 3.Owner's Name Last
FirstF
Owner's Address
Owner's E-mail Address
City
State F_
Zip �— Telephoned
ci 4. Architect/Designoes Name
Last First F— Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City �
State i
Zip F_ Telephone—
r 5. Engineer's Name Last
FirstI Lic No. �-
Engineer's Address
Engineer's E-mail Address
City
State �
Zip F_ Telephoned
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 HABARA
State CA
Zip 90631 Telephone 714-476-5370
OFFICE USE ONLY
PERMIT NO. �—' ?i0e17* OZY57
TYPE OF CONSTRUCTION
PLAN CHECK NO. )Ze0Zal - GP75)
OCCUPANCY- GROUP
PLAN CHECK FEE $