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Print Form Worksheet for Combo Building & Solar Perm 'ippecab n
r Comm'] r Residential City of Newport Beach - Building Division d '
NOTE: PLAN CHFCK FFFR ni IF AT TW= nr ci lcnn,77n.
1/7Building r Grading rDrainage F_ Elec r Mech F- Plum a,vdCut F_ cuvdFill
ProjectAddress(Not mailing address) F_ Flood rr—Fire r— Liq F Landslide f_N/A Floor Suite No
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Description of Work
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# Stories[ # Units (if Res)
Valuation $ >
New/Add SF�-- Remodel SFF---- -_— Garage/New/Add F_ Material/Labor r P
OWNER'S NAME Last
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Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last
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Applicant's Address
Applicant's E-mail Address
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City
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State
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ESIGNER'S NAME
Last . � t
First '
Lic. No.
Architect/Designer's Address
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Architect/Designer's E ad Address
City _., _ .,..
State F Zip — Telephone
ENGINEER'S NAME Last
First F Lic. No.�—
Engineer's Address -
Engineer's E-mail Address
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State F_ Zip TelephoneF- _
CONTRACTOR'S NAME/COMPANY
— Lic. No. F/02 q66 Class
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Contractor's Address
Contractor's E-mail Address
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State Zip q,77 S- Telephone T' nL3 i37�7
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SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES