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Comm'I F Residential City of Newport Beach - Building Division
j NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Cu Yd Cut Cu Yd Fill
Project address
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of Work
(- Flood
( Fire [ Liq
r Landslide [N/A Floor
Suite No
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New/Add SF�— Remodel SF b_— Garage/New/Add �—
OWNER'S NAME Last 1 I
f f e r �2r First �aw
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Owner's Address
Owner's E-mail Address
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City N e t,� pp r + State l�-/�� �— —_
l - -- t uT�._ ZIP qj 2j�4' Telephi
Use F Const Type
# StoriesrT # Units (if Res)7
Valuation $
Material/Labor
APPLICANT'S NAME Last (x y(p n First --�—
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Applicant's Address Applicant's E-mail Address
- _ Toar�eh S t nc 1 2e516rptiaVk- CA
City 6atALn_ /�� -- --
17.0 6'U 2.- State G r4_ . Zip Z� y .L._ Telephone I I La1.-7 013 Z
ARCHITECTfDESIGNER'S NAME Last
First �— Lic. No. F_—
ArchitecUDesigner's Address Architect/Designees E-mail Address
City State �— Zip �— TelephoneF—
ENGINEER'S NAME Last
Engineer's Address
-
City State
First
Engineer's E-mail Address
Lic. No.F—
ZiP �— TelephoneF�
CONTRACTOR'S NAME/COMPANY S
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Contractor's Address Contractor's E-mail Address
-7 2.2 I (2)ycol, ga il, a Ave..
City G Q Ckr1 rr,`VQ State e Zip QTelephoneo�
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO. )_QR20Z?-'ZzS3
PLAN CHECK NO. ZpZS CJ
PLAN CHECK FEES $