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Comm'77ResidentialComm'I Residential City of Newport Beach - Building Division
r NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Address (Not mailing
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OWNER'S NAME
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r'N/A Floor
Suite No
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Owners Address
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City IC6401416 ML MAIL State GRa
APPLICANT'S NAME Last
Applicant's Address
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# Stories # Units (if Res)7,
Valuation $
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Owner's E-mail Address
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Applicant's E-mail Address
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A lET/DESIGNER'S NAME LastCQW—VP40 First E kiZPq" Lic. No.
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ENGINEER'S NAME Last First�` �', Lic No.
Engineers Address IEngineers E-mail Address
City State Zip F7 -- TelephoneF __
CONTRACTOR'S NAME/COMPANY Lic No. F Class F77
Contractor's Address T 12,•n'
City State F_
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Contractor's E-mail Address
Zip Telephone
121-3082
PERMIT NO. X 2617-- 0 1 1 3
PLAN CHECK NO.
PLAN CHECK FEES $
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