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Comm] j _ Residential City of Newport Beach - Building Division �z
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL � Ja�1 0c,0
F7F Building F Grading Drainage r Elec (✓ Mech F Plum Cu vd cat Cu Yd Fill v
Project Address (Not mailing address) [- Flood F_ Fire F_ Liq F_ Landslide F_N/A Floor Suite No
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Description of Work
UseF Const Type®—
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# Stories # Units (if Res)F
New/Add SF Remodel SF Garage/New/Add
Valuation $
Material/Labor /
OWNER'S NAME Last First �7 — `���
Owner's Address Owner's E-mail Address
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City State
I ed Zip �� Telephone C'
APPLICANT'S NAME Last ,t First
Applicant's Address Applicant's E-mail Address
1334
Statev
City ..., JiL Zip ���0"..: Telephone
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ARCHITECT/DESIGNER'S NAME Last / First F_ Lic. No.
Architect/Designees Address Architect/Designer's E-mail Address
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City State �— Zip Telephone
ENGINEER'S NAME Last First Lic. No.1
Engineer's Address Engineer's E-mail Address
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City � State F--.-, Zip Telephone
CONTRACTOR'S NAME/COMPANY �/� GLo �L�SClass�G
Contractor's Address Contractor's E-mail Address
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City -� i / ._ ' State �— Zip �../l Telephone Z!, -7V
SETBACKS REAR SETBACKS FRONT PERMIT NO. XU14' ✓ D
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $