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PriniForm Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
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Project Address (Not mailing addrei
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Description of Work/%%
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F- Flood I— Fire F- Liq (- Landslide CN/A Floor Suite No
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OWNER'S NAME Last ��� First�,,�
Owner's Address
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Owner's E-mail Address
Zip
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APPLICANT'S NAME LastFirst
Applicant's Address A Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last First f r� Lic. No.
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Architect/Designer's Address Arch itect/Designer's E-mail Address
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City �-- State Zip �j Telephone
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ENGINEER'S NAME Last S'0pa First j�y�(C �• Lic.NoCF
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Engineer's Address Engineer's E-mail Address
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City Itff-c) ' State C� Zip � Telephone(Ro� �6� 0710
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CONTRACTOR'S NAME/COMPANY - 17 Lic. No. ��^ Class
Contractor's Address Contractor's E-mail Address
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City State Zip 9 /' 0 Telepho F-
SETBACKS REAR /6 ° %,'_'*)ETBACKS FRONT 20 Fn PERMIT NO.
SETBACKS LEFT �"�� SETBACKS RIGHT PLAN CHECK NO.
USEZONE DEVELOPMENT NO PLAN CHECK FEES $