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Worksheet for Combo Building & Solar Permit Application�� "°
Comm'I FJ Residential City of Newport Beach - Building Division o ,
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL roa^v
'Building F] Grading FDrainage [Elec 1Mech [l Plum Cuvdcut
CuvdFill
Project Address (Not mailing address) Flood '❑ Fire ❑ Liq ❑ Landslide ON/A Floor Suite No
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3311 hu.c.
Description of Work b
Use F-7 Const Type n
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# Stories # Units (if Res)❑
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New/Add SF Remodel SF Garage/New/Add
Valuation $
Material/Labo
OWNER'S NAME Last CA o S5.L je ( First
jsct $ P
Owner's Address Owner's E-mail Address
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City N Po State a /1— Zi q' L6 6 Telephone
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APPLICANT'S NAME Last F77 First
Applicant's Address Applicant's E-mail Address
City State F— Zip
F_ ,
TelephoneF_
ARCHITECT/DESIGNER'S NAME Last First
Lic. No. F7
Architect/Designees Address Architect/Designees E-mail Address
City State �' Zip
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TelephoneF
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ENGINEER'S NAME LastFirst Lia No.
J � L I_G_
-- --- —
Engineer's -Address ': Engineer's E-mail Address
City State, Zip
�� Telephoned
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CONTRACTOR'S NAME/COMPANY CAJ tM/ t-tA s N G9 J r Lic. No. 166 t J Class
Contractor's Address- Contractor's E-mail Address
3 811 /ri l S 0 c pti�` tc - i o Z
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City p ('U n RA /%/k& � Fs L State L —" ' Zip
cj 6'7 i Telephone 9 tio�n' ' —1 % �'
1
SETBACKS REAR SETBACKS FRONT PERMIT NO. - �C(,OL 6 — J0� 0
ETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
E ZONE DEVELOPMENT NO PLAN CHECK FEES $