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Worksheet for Combo Building & Solar Permit Applicationa4ggz
Comm'I Residential City of Newport Beach - Building Division R
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �•oa^" -
{—Building F_ Grading rDrainage F_Elec I: Mech )—Plum cuvdcuti Cu yd Fill
Project Address (Not mailing address) F_ Flood r Fire F_ Liq F Landslide F—N/A Floor Suite No
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D scription of Wo r
Use Const Type F
#Stories #Units (if ResJ�
Valuation $
Material/Labor
5i yam!/' 2 c> !-/Wig e 7 /2
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New/AddSFF Remodel SF�. Garage/New/Add
OWNER'S NAME. Last t°wvit-J First
Owner's Address Owner's E-mail Address
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City _ State ' Zip Telephone
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APPLICANT'S NAME Last 1 1 ,k�� First /�/yl�
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Applicant's Address Applicant's E-mail Adefess
2 Qo 5 3 vUwt C �.n v- 1 / iQ • Gl1�vr�/ �l 4Q.19
City State Zip Telephoner
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designees Address Architect/Designer's E-mail Address
City State �. Zip �— Telephoner
ENGINEER'S NAME Last First i . Lic. No. �$�%2�
Engineer's. Address C ` Engineer's E- il Address
City State Zip Telephoner
CONTRACTOR'S NAME/COMPANY / fs Lic. No. (GI8`%70CIass
Contractor's Address Contractor's E-mail Address
1_c)61 C-11 e,� Cli ` 51 i
City La kevbPeAl- State — Zip�tO Telephonej7(`f
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 5✓
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $