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0 Worksheet for Combo Building & Solar Permit Application
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City of Newport Beach - Building Division v
Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of Work
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Owner's E-mail Address
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APPLICANT'S NAME Last Gnr�S�
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Applicant's Address
Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last First �— Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
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ENGINEER'S NAME Last
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Engineers Address
Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY l a I I IV ( I VnTl lyn`� Lic.No. (9jU5)Z Class /' —
Contractor's Address
Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. �06I/q - -,jZ,,3,%
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. Ol "l-lsr(�"y IGj
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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