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Worksheet for Combo BuildnUf & Solar Pelrmft Appftaflon Out (e,Xp,Pe�� City of Newport Beach - Building Division Comm'I ) j/ residentialNOTE' PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not maillinig address) I- Flood ( Fire if Liq j' Landslide +-'N/A Floor Suite No
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Description of Work Pool/,Spa in 1P'1fCLJ el" W}R F?
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# Stories # Units (if Res)s
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Valuation $
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New/Add SFF— Remodel SFr-- Garage/New/Add �
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OWNER'S NAME Last Fs vi 1. i z First �—: /A r-7 _ ... �.
Owner's Address _ _ Owner's E-mail Address
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APPLICANT'S NAME Last �� Pub.f%Lf First
Applicant's Applicant's E-mail Address
_Address
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City . Vvl�Cj✓'�".... State Zip d u2� Telephone ZJ'5 T?9 aO.5
ARCHITECT/ ®SIGNER'S NAME Last F {G First & j'{-' Lic. No.
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Architect/DesignVs Address,, Architect/Designer's E-mail Address
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City GU j 'j'u} M 619 , - State Zip W r2a Telephone 2 3. 7 g `7 Z6 b 7
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ENGINEER'S NAME Last �� N2 First ff V Lic No.f
Engineers Address Engineer's E-mail Address
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City I V v ' State FcW—_ Zip I Telephone I Z T2•, s7 /
CONTRACTOR'S NAME/COMPANY BKv-,�w 1 Lic. No. F Class
Contractor's Address Contractor's E-mail Address
City StateZip-- Telephone ���1 . -'. oO U
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $