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Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
1. Project Address (Not mailing address)
1207 W. Bay Ave., Newport Beach, CA 92661
Tenant Name
2. Description of Work
r Fire Sprinkler F_ Fire Alarm r Fire Misc
Design build a new 3-story overhead RESIDENTIALfire sprinkler system in accordance with
2022 NFPA 13D - (34) sprinkler heads.
Extg Sq Ft New/Added Sq Ft 3.916 Total Sq Ft 3,916
Fx- New F_ Add F- Alter j— Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
# Units I
Use SFR
Valuation $ 4,300.00
# Stories
Fx- 3. Owner's Name
Last Boultinghouse First Brian & Morgan
Owner's Address
Owner's E-mail Address
1207 W. Bay Avenue
City Newport Beach
State CA Zip 92661 Telephone (310) 780-7042
F_ 4. Architect/Designer's
Name Last First F Lic, No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F Zip �— Telephone�—
rX 5. Engineer's Name
Last Vu First Anthony Lic. No. F1038755
Engineer's Address
Engineer's E-mail Address
1621 W. Sumac Lane
ifireprotectiondesign@gmail.com
City Anahiem
State CA Zip 92802 Telephone (714) 234-9633
Fx- 6. Contractor's Name
Last Nguyen First Vincent Lic. No. 0084661 Class 116
Contractor's Address
Contractor's E-mail Address
9182 Alwick Circle
xfreprotectiongroup@gmail.com
City Garden Grove
State CA Zip 92841 Telephone (714) 231-5108
OFFICE USE ONLY
0 "1 PERMIT NO. ��.
TYPE OF CONSTRUCTION
it�l PLAN CHECK
OCCUPANCY - GROUP
`tom— PLAN CHECK FEE $