HomeMy WebLinkAboutF2022-0505 - Permit ApplicationPrint Form Worksheet for Fire Permit Application
City of Newport Beach -Building Division
Please print 3 copies
Associated Building Permit # r Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
1 HERMITAGE LANE
Tenant Name POLOS RESIDENCE
2. Description of Work
FIRE SPRINKLERS
64 HEADS
Extg Scl Ft I — New/Added Sq Ft Total Sq Ft
New F- Add r Alter F- Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
# Units
Use
Valuation $ [6400
_.._
# Stories I2
i- 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City State
F_—
Zip F_ Telephoned
f- 4. Arch itect/Designer's Name Last
First F Lic. No.�
ArchitectlDesigner's Address
ArchitecUDesigners E-mail Address
City State
F—
Zip F— Telephone
r 5. Engineer's Name Last
First F_ _._.-.- Lic. No.
Engineer's Address
Engineer's E-mail Address
City State
F—
Zip F_ Telephoned
r S. 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. f-tvu' °5bS
TYPE OF CONSTRUCTION
PLAN CHECK NO. -RL2oL1
OCCUPANCY- GROUP
PLAN CHECK FEE $