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K Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building F`, Grading i—Drainage �,!Elec F Mech Plum j
f'� f Cu Yd Cutl Cu Yd Fill l
Project Address (Not mailing address) I— Flood F- Fire f— Liq F- Landslide -N/A Floor Suite Ni
12� �2uw
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Description of Work
Use F Const Type
vZ v�S v6� -_ -
# Stories? # Units (if Res)r
` PZ t� `� ` �4acu�v 1 l 4 � 0 Nvo k Y)S-k
New/AddSFF— Remodel SF Valuation Garage/New/Add Material/Labor
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
City State ZIP �— Telephone - -
APPLICANT'S NAME Last i First
�
Applicant's Address
Applicant's E-mail Address
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:City 11���State CI __ --
��EriY10ZipTelephone
ARCHITECT/DESIGNER'S NAME Last
First F� :Lic. No.
Architect/Designees Address Architect/Designer's E-mail Address
city State F Zip Telephone[
—
i
ENGINEER'S NAME Last I First
_ __ Lic. No.�-
Engineer's Address Engineer's E-mail Address
City--" State �_ Zip �— Telephoned --
CONTRACTOR'S NAME/COMPANY Class
91 CiC �1exrtcs �gGUb G
Contractor's Address Contractor's E-mail Address
7�20 Yk,s 5k ,N .A
--
city _4 State
ZIP
Telephone �6 mel , 'Soq
SETBACKS REAR SETBACKS FRONT PERMIT NO.—(C
SETBACKS LEFT SETBACKS RIGHTD � 2
PLAN CHECK N0.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $