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Worksheet for Combo Building S Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) F_ Flood (- Fire r Liq r Landslide rN/A Floor Suite No
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Description of Work
Use Const Type F
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# Stories # Units (if Res)F_
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Valuation $
New/Add SFI Remodel SFF—Garage/New/Add F—
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Material/Labor /o/
OWNER'S NAME Last : y V 'I • �-u cow � v FirstCj
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Owner's Address wner's E-mail Address
City I— State � Zip F— TelephoneF_
APPLICANT'S NAME Last /7 A/ First I,/J�
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Applicant's Address Applicanfs E-mail Address
City State 7Vt-_ Zip 07 Telephone III • 1%8
ARCHITECT/DESIGNER'S NAME Last First F_ Lic. No. F_
Architect/Designer's Address Architect/Designer's E-mail Address
City State F_ Zip F Telephoner
ENGINEER'S NAME Last First F_ Lic. No.r—
Engineer's Address Engineer's E-mail Address
City State F_ Zip F_ Telephoned
CONTRACTOR'S NAMEICOMPANY V r / t �, i Lic. No. rWq_ft2Class G' K�
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Contractor's Address E-mail Address
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City G /j State I Cpr Zip Telephone gQgG'
SETBACKS REAR SETBACKS FRONT „ PERMIT NO.
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SETBACKS LEFT SETBACKS RIGHT ��!' ^L PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $