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City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) Flood
Fire iq Landslide F_N/A Floor Suite No
Description of Work
Us onstType
# Stories •. # Units (if Res)F
Valuation $
New/Add SFF— Remodel SFF—Garage/New/Add F—
L_
Material/Labor ', E -' L
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OWNER'S NAME Last l_•l�;'C%t' Z E V—
First
Owner's Address
Owner's E-mail Address
City State 1�
Zip Telephone
APPLICANT'S NAME Last / r� �L �,
First i L
Applicant's Address
Applicant's E-mail Address
City\ V.` J` t t -F State �r�-
Zip 6,zCr Telephone
ARCHITECT/DESIGNER'S NAME Last First F Lic. No.
Architect/Designees Address
Architect/Designees E-mail Address
City I State
Zip Telephone)
ENGINEER'S NAME Last
First L � Lic No.�� ,
Engineer's Address
Engineer's E-mail Address
City �� t�C1 ��: 1\ State fT
Zip J�CE;'( Telephone
L
•
CONTRACTOR'S NAME/COMPANY f
Lic. a
Contractor's Address
Contractor's E-mail Address
City State F_
Zip F__ TelephoneF_
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEF SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $ F50 ,