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Frrnf otrn ':. Worksheet for Combo Building & Solar Permit Application
(— Comm'IIK Residential
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j�Building r -Grading F -Drainage F_Elec F_Mech
("-Plum cuydcut! i? cuvdFill G2
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Project Address (Not mailing address) f— Flood Fire Liq j" Landslide FN/A Floor Suite No
2(2 Moojwc, cowyoN
Description of Work
Use Const TypeV i
(J11 $lN6(� FRMlLY �1AGEt� ISIk)EiUCG'-
�-n
#Stories # (if Res)
,,��.//�
i�
/
New/Add SF 4 �3 Remodel SF Garage/New/Add '24'%
Valuation
Material/Labor (�a0O
OWNER'S NAME Last I-SCIMC7 Q6a
First STA Cry Jazoih 6 -
Owners Address
Owner's E-mail Address
?q OW coves
&,k-CEf50(JMEI0g2@6MRIL,COM_
City I KojP091-_.._Dcpg,bt -. State �,,.
Zip _&7,04;P_ Telephone q¢ X20-62¢0
APPLICANT'S NAME Last I khq
First ✓lCV
Applicant's Address
Applicant's E-mail Address
V(9 Wk&-
Sn/*pQ6 o,59/v4rzcw-ITE ,ai
City € � _... _. State w'.._
Zip.. Rowe _.. Telephone W 9 Q.So 6 7;%
ARCHITECT/DES's--SNER'SNAME Last O(y$'ON------- First ,� ',..� Lic. No. 151?4 4
Architect/Designer's Address
c
-Architect/Dsigners E-mail Address
(_
City (Q�//v�{.... State CA.
Zip r-( 24/? Telyphnne yqq. 45062)93
ENGINEER'S NAME Last r'NUSI'l�!%>�,i�......
4'
u.. _... First p{l`(Ls...... _.... Lic. No. 4'
Engineer's Address
,Engineer's E-mail Address
��f 09. �^`lP US pRl(/E
1p(1)F/f9lu5/��Iht^/A�G9T/Vl
SG/tyU°. CO/r'I
City Nbljpvz r ga'Gy State )
Zip 'l' a,2 Telephoned '752 111
CONTRACTOR'S NAME/COMPANY Lic. No.F Class
Df�
Contractor's Address
Contractor's E-mail Address
F3_ A-9 Ae1zPQd'r L00,P b2
��------ —
City f G9sl7`} MCS -.._..._..,__._.__. State CA
Zip 92G2b ',. Telephone T —113r,>
SETBACKS REAR SETBACKS FRONT
PERMIT NO. -" 1.,5. 2-A a 4
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $