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copies Worksheet for Fire Permit Application
Please print 3 cop°�`W'°"
- City of Newport Beach - Building Division v _
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Associated Building Permit # rx Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
18 Pinehurst Lane
Tenant Name
2. Description of Work
Design and Installation of Fire Sprinkler System per NFPA 13D
Extg Sq Ft F_ New/Added Sq Ft F_ Total Sq Ft 9,797.4
r New r Add F_ Alter r Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
# Units F—
Use
Valuation $ 19,765
# Stories
r 3. Owner's Name Last First
Owner's Address Owner's E-mail Address
City State I- Zip r Telephone—
r 4. ArchitecVDesigner's Name Last Gutierrez First Rubi Lic. No.�
Architect/Designer's Address Architect/Designer's E-mail Address
8085 E. Crystal Dr. RubiG@resfire.com
City (Anaheim State CA Zip 92807 Telephone (714)666-8450
r- 5. Engineer's Name Last First Lic. No.
Engineer's Address Engineer's E-mail Address
City State F Zip I — Telephonel—
r 6. Contractor's Name Last Residential Fire Systems First i — Lic. No. 786965 Class C-16
Contractor's Address Contractor's E-mail Address
8085 E. Crystal Dr. engineering@resfire.com
City Anaheim State CA Zip 92807 Telephone (714)666-8450
OFFICE USE ONLY PERMIT NO. ^,,1w12
TYPE OF CONSTRUCTION PLAN CHECK NO. f ppry� 2 2'f" 0 I00
OCCUPANCY- GROUP PLAN CHECK FEE $