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City of Newport Beach - Building Division X z
[ Comm'I [Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL U
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Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq ❑ Landslide [N/A Floor Suite No
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Description of Work A
Use [7 Const Type
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# Stories17 # Units (if Res)
Valuation $
Material/Labor S 007C7
New/Add SFRemodel SF17-771 Garage/New/Add
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OWNER'S NAME Last ail Q Un ( First 6i {177
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Owner's Address Owner's E-mail Address
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City (rVI f)e State c� Zip � Telephone U����I
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
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City State `-I— r! J Zip Telephone�O . Yb(
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip Telephoned
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ENGINEER'S NAME Last I (p, {�L/ First Lfc. No.
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Engineer's Address Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY I e — a e Maker r i Lic. No. 6 /L�3 : Class Mart'
Contractor's Address oil
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City �(j5 �eSg State F CT Zip C7/XTA� Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. Y- Z t�L — D9
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 03,-_2 - Z�
USE ZONE DEVELOPMENT NO ZCS(%li l7 ] PLAN CHECK FEES $