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Print Form, Worksheet for Combo Building & Solar Permit Application ?Ew°° m
❑ Comm'I Residential City of Newport Beach - Building Division ° q
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ~
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❑Drainage ❑Elec ❑Mech ❑Plum cuvdcut= Cu Yd Fill
Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq ❑ Landslide CIN/A Floor Suite No
Descripittorlof Work
Use Const Type
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# Storie I# Units (if Res)
Material/Labor
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New/Add SF =
� 'Valuation
Remodel SF [Garage/New/Add
OWNER'S NAME
Last First �—
Ow,ier's Address
Owner's E-mail Address
City
State �J Zip [7= Telephone
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APPLICANT'S NAME
Last L— First —
Applicant's Address
Applicant's E-mail Address
City �—
I State Zip Telephoned
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City �—
i State Zip L Telephone
ENGINEER'S NAME
Last First � Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State �— ZIP L—:= Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractor's Address
Contractor's E-mail Address
City
State Zip Telep
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SETBACKS REAR
—
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK N
USE ZONEff
DEVELOPMENT NO PLAN CHECK FEES $
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