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Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address
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Description of Work
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A -F W otr/Irrl&
New/Add SF N/q
OWNER'S NAME
(Not mailing address) F_ Flood j- Fire F_ Liq F_ Landslide O�N/A Floor Suite No
RA' -f no,,as 1 1 (
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it
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Remodel SF 9- , G:
Last I S kc>c _el
Use �4(JAI Const Type
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r• r4J FAq„/.`/ g6 as i # StorieslT # Units (if Res)
Valuation $ qq
e/New/Add Material/Labor 06,001z,
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FirstP _Tb�& 't -ref:=
Owner's Address Owner's E-mail Address
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City /•./�(.Je°O/!la �ljCq-pM State I v Zip �� Z. Telephone
APPLICANT'S NAME Last
Applicant's Address
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City 1114UAAe-ov ...... State CF1-
ARCHITECT/DESIGNER'S NAME Last First , Lic. No.
Architect/Designers Address Architect/Designer's E-mail Address
City _ State �Zip Telephoned'
ENGINEER'S NAME Last �`yj fTr2pr !(; First l J Lic. No.�C%yZr f
Engineer's Address
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City /0uAACT a State Fiii
Engineer's E-mail Address .
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Zip 91S-Ioa Telephone %fe/ o.!5--7b_5_(-
CONTRACTOR'S
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CONTRACTOR'S NAME/COMPANY Meofileae, Lic. No. 9x960,2 Class
Contractor's Address
Cityl Zi05 ASA rivJ State li,4
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
Contractor's E-mail Address
/1'`%2 f.�.�Sf,¢ , c, -r �.✓ @ GM .4r� Govt
Zip 47.7,0 Telephone( $�76-'_5�8W _... _..
PERMIT NO. )o4 t % "2,1A.6
PLAN CHECK NO. I • t.DSr- U I1 Yi
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $