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Comm'l r( Residential City of Newport Beach -Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of Work CWceao&SNuT
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OWNER'S NAME Last
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Owner's Address
Owners E-mail Address
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APPLICANT'S NAME Last ,.Mt.1len.
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Applicant's Address
Applicant's E-mail Address
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ARCHITECT/DESIGNER'SNAME Last Z_%AkWS'
First Lic. No. -
Architect/Designees Address
ArchitectlDesigners E-mail Address
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ENGINEER'S NAME Last --- ----
, First F7777— Lic. No.�2
Engineer's Address
Engineer's E-mail Address
City State F__
Zip I -�I, Telephone
CONTRACTOR'S NAME/COMPANY b (-�-7 - Li�f!1.... ry r -1• _-� _ Lic No..'63Wn-4.. C_Ilass✓`7
Contractors Address
Contractor's E-mail Address
city ( LA(.L /a' E-1 State FC7�Qr7,zip
I 1 24,l ) 'Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.%
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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