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Worksheet for Combo Building & Solar Permit Application
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City of Newport Beach - Building Division
r Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
IZBuilding r Grading rDrainage r Elec I— Mech
r Plum Cu Yd cutF Cu Yd Fill F
Project Address (Not mailing address) F_ Flood I— Fire r Liq r Landslide FN/A Floor Suite No
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Description of Work
Use F—ConstType F
#Stories #Units(ifResj-
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Valuation $
New/Add SF 9v _ 13 ReRemodel SFr— Garage/New/Add �
Material/Labor 147,0-
OWNER'S NAME Last xv-Dulr First G(SNN
Owner's Address
Owner's E-mail`Address
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APPLICANT'S NAME Last Ni
First
Applicant's Address
Applicant's E-mail Adddr��ess
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ARCHITECT/DESIGNER'S NAME Last First �— Lic. No. �—
Architect/Designees Address
Architect/Designees E-mail Address
City State
Zip TelephoneF—
ENGINEER'S NAME Last
First I— Lic. No.r—
Engineer's Address
Engineer's E-mail Address
City State F_
Zip Telephone
CONTRACTOR'S NAME/COMPANY
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Lic No. 16(y ri{p Class �I
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Contractor's Address
Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. PC 2OZZ" 31S
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $