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Print Form Worksheet for Combo Building & Solar Permit Application ewP°R,
City of Newport Beach - Building Division ��
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL =P
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Description of Work
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# Storied #Units (if Res)
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Owner's %Address y Owner's E-mail Address
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City F--- — State � ZipF Telephone en
APPLICANT'S NAME Last ('�� 1. fr�'�7 First _4e
Applicant's Address Applicant's E-mail Address
City State CA Zip (_- Telephone
ARCHITECT/DESI ER'SNAME Last � �A �� Firstr
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, ,, Lic. No.�
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Architect/Designer's Address �- Architect/Desiail Address
City F State F Zip Telephone[
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ENGINEER'S NAME First , C ., ic. No.
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Address
Engineer's Engineer's E-mail Address "�
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City State F Zip F TelephoneF
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CONTRACTOR'S NAME/COMPANY �-- ic. No. ��ZSvZ Class
Contractor's Address Contractor's E-mail Address
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city I '— cJ. State ( r a Zil)"Ibg cog Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. .. 1Z.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N
USE ZONE DEVELOPMENT NO PLAN CHECK FETE -SS