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Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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'roject Address (Not mailing
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❑ Flood ❑ Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
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Use 177 Const Type F
# StoriesC # Units (if Res)F'
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New/Add SF��I Remodel SF F-77-7 Garage/New/Add Material/Labor /
OWNER'S NAME Last
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Owner's Address - Owner's E-mail Address
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City State Zip Telephoned
APPLICANT'S NAME Last
Applicant's Address
City State
First
Applicant's E-mail Address
Zip Telephoned
ARCHITECT/DESIGNER'S NAME Last First _ J' Lic. No.
Architect/Designers Address
City _ State Fel
Architect/Designees E-mail Address
Zip ^I, Telephoned'
ENGINEER'S NAME Last J First Lic. No.0
Engineers Address
City', State
Engineers E-mail Address
Zip �'�, Telephoned!,
CONTRACTOR'S NAME/COMPANY — J Lic. No. 6371 Class
Contractors Address
City _ State
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Contractors E-mail Address
Zip —', Telephone
PERMIT NO.
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $