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- Comm1 r Residentirl City of Newport Beach - Building Division ,
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL G4�p°"'�
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Project Address (Not mailing address) C Flood
r/Fire [ Liq Landslide _N/A Flllioor Suite No
Description of Work
Use Const Type
# Stories # Units (if Res)F-
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Valuation $l � 6 ( —C,
Material/Labor i
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New/Add
OWNER'S NAME Last
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Owner's Address _
Owners E-mail Address
city IV _ State I
,, ` Telephone
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APPLICANT'S NAME Last I J M (i I i Firstyl/(q(�
Applicant's Address
Applicants E-mail Address
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ARCHITECT/DESIGNER'S NAME Last F-
First F_ Lic. No. �—
_ Architect/Designer's Address
Architect/Designers E-mail Address
City State �--
Zip — TelephaneF_
ENGINEER'S NAME LastFX D e
First ( T RIO L_- Lic.No.�`�
Engineer's Address
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Engineer's E-mail Address
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City State 34 -ZIP
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I l / D� Telephone `] %G !� (7 d, DS�
CONTRACTOR'SNAME/COMPANY S SKvh-4 0 Ns (_ Lic. No. 7/./40 Class�-
Contractor's Address
Contractor's E-mail Address
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City iw Nt1 State I Y
Zip it T -7C) Telephonel 14 �3g 1q/
NO.
SETBACKS REAR SETBACKS FRONT
PERMIT
SFTRACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $