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r Worksheet for Combo Building & Solar Permit Application sa-W
Print Form
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Residential City of Newport Beach - Building Division NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTALF-Building F_ Grading j-Drainage r Elec F_ Mech r Plum Cu Yd Cutl Cu Yd Fill
Project Address (Not mailing address) h Flood F- Fire F- Liq F_ Landslide F_N/A Floor Suite No
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Description of Work i0� _—cam 3� i Use F—Const Type F_
V,� � ug 5� Q r Stories # Units (if Res)[ —
Valuation $
New/Add SF F__ Remodlel SFF F-- �- Garage/New/Add i Material/Labor 115
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OWNER'S NAME Last IL''jt/ ` ®ti First Z Y
Owner's Address Owner's E-mail Address
City P ! / State FW Zip F— Telephone 7-jV L ZSL
APPLICANT'S NAME LastFirst�5
rApplicants Address Applicant's E-mail Address
City � ,g r � State Zip(—_ Telephone
ARCH ITIEC�T/DESIGNER'S NAME Last ��� First �L Lic. No✓crLF—
ArchitecUDesigner's Address Architect/Designer's E-mail Address
city�C State Zip— Telephone
ENGINEER'S NAME Last L`S First �Y- G Lic No. C'Z/�q„�/"� Y/L�.7(
Engineer's Address Engineer's E-mail Address �(..��
�w� ��5.tl - iR`� Z�� ��� C
City '/ , � 4eState e� _ Zip F— Telephone 77,V � �
CONTRACTOR'S NAME/COMPANY Lic No. � ClassF—
Contractor's Address 7 Contractor's E-mail Address
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City I /L) rl� State �� Zip /J� Telephone 7/[L_
SETBACKS REAR SETBACKS FRONT `C PERMIT NO. l XZ-I ✓— �! U' U
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $