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Worksheet for Combo Building & Solar Permit Application City of Newport Beach - Building Division
(- Comm'1 Residential �c4wp�
NOTE' PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ��`a� e
F-46lding (-Grading F -Drainage �r6ec F_Mech 1. Plum CurdcutF Cu Yd Filll
Project Address (Not mailing address) [ Flood F- Fire F- Liq F Landslide [N/A Floor Suite No
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Description of Work
Use Const Type
#Stories #Units (if Res)
,,41
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Valuation
Material/Labor IIJJ CJ
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New/AddSF�— Remodel SFl Garage/New/Add
OWNER'S NAME Last FLVOL Y- _ First I D(Z ()01'^ _
Owner's Address Owner's E-mail Address
q 3 y 3 V'wgarNzz, ¢vG
Telephone '� (t ••GCv3
City _ veiv � ro - 7j 97 a Ack, State I CA _,.. _ Zip - ; 'CCri
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APPLICANT'S NAME Last IV -i I I AI.-A-e'vo- First
Applicant's Address Applicant's E-mail Address
F q /G! l�% GLYow /� iii SING �0�2 O f \ :Lot�•LOaw
City ,�r„„�L,,.�tw _. State C ZipIC('L�66 Telephone['32-3 tom(
ARCHIT /DESIGNER'S NAME Last ;\\p, v Q�J c First � SOr^ Lic. No. F—
Architect/Designers Address Architect(Designer's E-mail Address
qty State 1 Zip �— Telephone
ENGINEER'S NAME Last First F— Lic. No.17—
Engineer's Address Engineer's E-mail Address
City State �- Zip Telephone{
CONTRACTOR'S NAME/COMPANY b C 5(,y^4 Aw'A Lic. No. FONO7 Class,, 5
b
Contractor's Address Contractor's E-mail Address
I�.y.)�"vso, �r
',IPw.�S.Ga
city �A --Vow f<_- State � c A - Zip l'f�CJ 11 Telephonef
SETBACKS FRONT b PERMIT NO_ (_}✓ y --y'(j7
SETBACKS REAR
SETBACKS LEFT SETBACKS RIGHT ;�j [`/PLAN CHECK NO.
USE ZONE DEVELOPMENT NO ` AZO v_ I PLAN CHECK FEES $ trig"'