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r Comm'I r Residential City of Newport Beach- Building Division
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Project Address (Not mailing address) r Flood
r Fire r7 Liq Landslide F_N/A Floor Suite No
170
Description of Work
Ci
Use Const Type
# Stories= # Units (if Res)r,—
Valuation $ ✓'
Material/Labor
New/Add SF[ Remodel SF��
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Garage/New/Add
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OWNER'S NAME, Last
First
Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME last
First
Applicants Address
Applicant's E-mail Address
City State F
Zip F_ TelephoneF_�
ARCHITECT/DESIGNER'S NAME Last F First Lic:No. F_
ArchitectfDesigner's Address '
Architect/Designer's E-mail Address
City State ��
Zip �� Telephone[—.�
ENGINEER'S NAME. Last F�
First �'� Lic. No.r—
Engineer's Address -
Engineer's E-mail Address
City F State F_
Zip Telephone -
CONTRACTOR'S NAME/COMPANY
Lic W�*Class
Contractors Address
Contractor's E-mail Address
City State
Zip Telephone
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' SETBACKS REAR SETBACKS FRONT
10 1
PERMIT NO. � ^ k& oV
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $