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Worksheet for Combo Building & Solar Permit Application Q
Cityof Newport Beach - Building Division
j` Comm'I (— Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[—Building r Grading F—Drainage F_ Elec Mech j— Plum CuvdCut I CuYdFill I
Project Ad re s (Not mailing address) (� Flood j— Fire f Liq F_ Landslide f N/A
Floor
llacrrintlOn of Work
11:
i sys�
New/Add SFF_
Remodel SF
OWNER'S NAME Last
Owner's Address
C ity
LPPLICANT'S NAME Last
M
%A-Acl. CIF _ 7-W40
Use I Const Type
+e'1
Garage/New/Add F—
First
Owner's E-mail Address
Suite No
# StoriesF_ # Units (if Res)r—
Valuation $
Material/Labor
State F----- Zip F_ Telephone
Applicant's Address
City (rIVIM, State
ARCHITECT/DESIGNER'S NAME Last
Architect/Designer's Address
City V 4� 6
ENGINEER'S N✓1
AME Last
Engineer's Address
First f 14; C.k
Applicant's E-mail Address
Zip � � Telephone 441q.1,11,&JX45
First Lic. No.
Architect/Designer's E-mail Address
State Zip gy-*Oy5 Telephone
First
Engineer's E-mail Address
Lic. No.
Ciiy
(� State F_ Zip I Telephone —
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City iry
Lic. No. jApppyo Classl
SWIAr•�- gYsr(CW15 ?1c.Glna��31�
Contractor's E-mail Address
i sCIVI. cc'fri V° & \
Telephone
State �,.— Zip ��/
SETBACKS REAR SETBACKS FRONT ���1 �
SETBACKS LEFT _ SETBACKS RIGHT
G
USE ZONE DEVELOPMENT NO
kERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $ �_ _�—�—