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F'rlr;tFolm Worksheet for Combo Building & Solar Permit Application o��EWPORa
[—I Comm'I ❑Residential City of Newport Beach - Building Division l'
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL u
❑Building ❑ Grading ❑Drainage ❑ Elec ❑ Mech ❑ Plum Cu Yd CutF7 Cu Yd Fill ❑
Project Address (Not mailing address) ❑ Flood ❑ Fire [J Liq ❑ Landslide ❑N/A
Description of Work
7VGw ItrTAc/4 C f-) 46S �jr BQ.t_.tiY 0/y z1& -V/ �sT Si
New/Add SF Remodel SF
Floor Suite No
F_7
Use ConstType �I
a # Stories❑I # Units (if Res)
Valuation $
Garage/New/Add Material/La r '
OWNER'S NAME Last First
Owner's Address
City �— State
Owner's E-mail Address
Zip Telephone
APPLICANT'S NAME Last �� (,� First
Applicant's Address Applicant's E-mail Address
City I P-o�,14%1ji /J6((jgTS I State ~'Zip ClJ7�,S Telephone z - —,s
ARCHITECT/DESIGNER'S NAME
Last W l� First g� Lic. No.
Architect/Designer's Address
City F(^irlL'� �� �'C �S i State
Architect/Designer's E-mail Address
Zip Telephone
ENGINEER'S NAME
Last i First I Lic. No. I
Engineer's Address
I
City State L i
Engineer's E-mail Address
_I
Zip Telephone
CONTRACTOR'S NAME/COMPANY �� w C Lic. No. -( Class3
Contractor's Address v
City � o & l (i Mi (S State C
SETBACKS REAR SETBACKS FRONT
Contractor's E-mail Address
F_
Zip Telephone V 4- ' . -e � � C 1 T
PERMIT NO. WAVI - Hv
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $