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Ci of New ort Beach - Buildin Division
Comm'I 'r Residential NOTE: PLAN CHECK FEFS Ill IF AT TIRAP OF cI IPIRAI=Ai
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Building F7Grading [-Drainage F_Elec F_Mech j-Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) r Flood [_ Fire r Liq r Landslide �N/A Flnnr Suite No
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Description of Work
Use Const Type
Resl4ce
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# Stories # Units (if Res)
1 \ale(
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New/Add SF _ _ _ - Remodel SF
Garage/New/Add �—
Valuation S
Material/Labor
OWNER'S NAME Last
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First PQ,t,l.l
Owner's Address
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Owner's E-mail Address
City re - C 1 e_qv,.._ _ State Zip �.._>b Telephone _I (3Fck7
APPLICANT'S NAME Last f 211
First
Applicant's Address
Applicant's E-mail Address
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City /� State �—
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Zip ZgyL. _ .Telephone ' ) 2
ARCHITECT/DESIGNER'S NAME Last First
---- - Lic. No. F—
Architect/Designer's Address
Architect/Designees E-mail Address
City State �—
Zip F— Telephone�—
ENGINEER'S NAME Last
First Lic. No.�—
Engineer's Address
Engineer's E-mail Address
City F State F_
_
ZIP Telephone—
CONTRACTOR'S NAME/COMPANY S1 S►1 a l R¢ Star4 } m r Lic No. lass
Contractor's Address
Contractor's E-mail Address
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City I GgT.At.1 G rr v r, State FQ AC—
Zip Eg44 . ..Telephone . iy) 7 31, 1453 Z
SETBACKS REAR SETBACKS FRONT
PERMIT NO. XRZO23- 2. Z,SZ,
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. P52QZ3- IC17q
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $ f