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City of Newport Beach - Building Division
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OWNER'S NAME Last go J! _O/{/
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APPLICANT'S NAME Last
Applicant's Address
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ARCHITECT/DESIGNER'S NAME
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Applicant's E-mail Address
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ENGINEER'S NAME Last
Engineer's Address Engineer's E-mail Address
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City �Us e/I�% State '� Zip Telephone
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CONTRACTOR'S NAME/COMPANYMNnNg!
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State Zip g6bT-g Telephone 32 3 — 244
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SETBACKS FRONT V 1'-112j. PERMIT NO. A—wA—o71pg'� f ✓ I✓' -og�
SETBACKS REAR G SETBACKS RIGHT i, PLAN CHECK NO.
SETBACKS LEFT
PLAN CHECK FEES $
USE ZONE DEVELOPMENT NO
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