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Print Form Worksheet for Combo Building & Solar Permit Application Q
Comm'I jesidential City of Newport Beach - Building Division NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Ouilding F_ Grading r!Drainage Klec V .Nech lum cuYdCut- cuYdFill
Project Address (Not mailing address) [ Flood r Fire r, Li rl Landslide FN/A Floor Suite No
Description of Work �QJ
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Use nstType U (3
71.
# Stories #Units (if Res)
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New/Add SF � Remodel SFI
Garag �� a/New/Add ,
Valuation F
Material/Laa bor �r
OWNER'S NAME Last r�� ..,�...__
First _. _.. i�-..... '.
Owner's Address
Owner's E-mail Address
city ,p u � v �t �.J l,- State 1 Zip �"Zim (� Zu Telephon 9
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City f State F—
Zip [_ Telephoner
ARCHITECT/DESIGNER'S NAME Last
First I Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City r _ State �—
Zip Telephoner
ENGINEER'S NAME Last
First —... Lic No.f-..----'.
Engineer's Address
n e aP)n
City StateZip
e
CONTRACTOR'S NAME/COMPANY 'r tl�
�� �`� Lic. No, 539?-b� Class
Contractor's Address
Contractor's E-mail Address
City �h-J State I
Zip ��� . Telephone 1ti. "3�__13 St./ .....
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT I A
#Vw^ &P AN CHECK NO.
USE ZONE DEVELOPMENT NO
LAN CHECK FEES $