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F Cornm'I Residential
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City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Building r Grading
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Project Address (Not mailing address) F_ Flood F_ Fire F Liq F_ Landslide N/A FloorSuite No
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Description of Work
Use /LeS Const Ty
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P, 8<-f4l ! 04
6 sP 6kr AdJ 41 /
It Stories #Units (if Res)r
Valuation $ 3 30o.,
Material/Labor F-4
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New/AddSFa�
RemodelSF� Garage/New/Add
OWNER'S NAME
Last L First
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Owner's Address
Owner's E-mail Address
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City
State ( Zip 9/7 Telephonef 904 - Zc j iy7
APPLICANT'S NAME
Last! ( First
Applicant's Address
Applicant's E-mail Address
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City �Cw r
State �— Zip 91 Z TelephoneF
ARCHITECT/DESIGNER'S NAME
Last FirstLic No.
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Architect/Designer's Address
Architect/Designer's E-mail Address
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Ar,R, 66A P_ /k(
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City tr�AC YAY4
State `� Zip1755_ Telephone q5 -f- 74-f- 7Ss13
ENGINEER'S NAME
Last C �� r h� First Lic. No.[_o r 77]
Engineer's Address�%
Engineer's E-mail Address
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City r ^ a
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State Ch Zip :.9ZPf-o Telephone C15 ]�73i�- UK
CONTRACTOR'S NAME/COMPANY Lic No. 9y7SZt( Classl
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Contractor's Address
Contractor's E-mail Address
/Z 37
TPS
City I/ I�, J
State Zip 57i 6 Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT NO.�
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK N0. r
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $