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City of Newport Beach - Building Division TNOTE:
PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) r- Flood r Fire F_ Liq r Landslide T_N/A Floor Suite No
Description of Work
Use Const Type
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New/Add SFr--
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Valuation
Material/Labor
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OWNER'S NAME
Last
`Ja°I!✓2�LT._ First
Owner's Address
Owner's E-mail Address
City�n
State Zip Telephone
APPLICANT'S NAME
Last
First
Applicant's Address
Applicant's E-mail Address
City
State F Zip �— Telephoner—
ARCHITECT/DESIGNER'S NAME LasFirst
Last AL yg�
-1 46_7e7-$ Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
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State Zip Telephone alge�) _4 --1(
ENGINEER'S NAME
Last
First F— Lic. No.�—
Engineer's Address
Engineer's E-mail Address
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City
State r-- Zip �— Telephone
CONTRACTOR'S NAME/COMPANY1
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Contractor's Address
Contractor's E-mail Address
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State I e� Zip Z (� Telephonel���
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city -
SETBACKS
REAR
SETBACKS FRONT PERMIT NO.
SETBACKS
LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE
ZONE
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