HomeMy WebLinkAboutXR2023-3139 - Permit ApplicationPrint Form
Worksheet for Fire Permit Application ?fWRR
City of Newport Beach - Building Division a
Please print 3 copies G,' op„„
Associated Building Permit #
r Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
1233 BLUEGUM LANE F �—
Tenant Name CHATRISA RESIDENCE # Units
2. Description of Work
FIRE SPRINKLERS
Use
37 HEADS
Valuation $ 3700
EMg Sq FtF New/Added Sq Ft F_ Total Sq Ft
# Stories F
r New I— Add F—Alter (— Demo
Check Appropriate Box for Applicant/Notification
r 3. Owner's Name Last
First F_
Owners Address
Owner's E-mail Address
City
State 7 Zip F— Telephoned
r 4. Architect/Designer's Name
Last First Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State Zip 11 Telephone
r 5. Engineer's Name Last
First I— Lic. No.�
Engineer's Address
Engineer's E-mail Address
City
State F__ 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 HABRA
State CA Zip g0631 Telephone 714-476-5370
OFFICE USE ONLY
Ta-w— &O PERMIT NO.
TYPE OF CONSTRUCTION
X - ?�y✓G+ PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $
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