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Print Form Worksheet for Combo Building & Solar Permit Applilio tw
Comm'I Residential City of Newport Beach -Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of Work
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OWNER'S NAME Last I W -,Ix; .S
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Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last �jaY•�.
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Applicant's Address
Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last 'S
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Architect/Designer's Address
Architect/Designer's E-mail Address
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ENGINEER'S NAME Last Mo rslr\a Ad
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Engineer's Address
Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY �� �' i 1'Yiy/O_ Lic No. FG1G ,:I� SZ Class
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Contractor's Address
E-mail Address
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. X2-0 I q'.G-9653
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. ^ZZ0 ..��,0
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $ 111