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Print Form Worksheet for Combo Building & Solar Permit Application ��"""° m
j- Comm'1 r Residential City of Newport Beach - Building Division o
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL o• •'
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Project Address (Not mailing address) r- Flood r Fire r Liq andslide rN/A Floor Suite No
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Description of Work
Use i-5 Const Type P-6
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#riesL # Units (if Res)F_
Valuation $
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New/Add SFF+ 2G3q Remodel SF 067 Garage/New/Add
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OWNER'S NAME Last 9ule,cfiu. First Aryl"j Aap VAIZ d
Owner's Address Owner's E-mail Address
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APPLICANT'S NAME Last STAr4O First $iEyE
Applicant's Address Applicant's E-mail Address
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City Auso Jtaao State I Zip FCIU56 Telephone �4� %-t7-`1304
ARCHITECT/DESIGNER'S NAME Last $1;Ak6 First $ f EtE Lic. No. C- 2° ?) I
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Architect/Designees Address Architect/Designees E-mail Address
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City Auso 6vi o State Zip , j265(� Telephone (�A`11(rn- 11364
ENGINEER'S NAME Last MDt41TR2 First FTARIFle, Lic. No. S- 4(Sc1
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Engineer's Address Engineer's E-mail Address
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City�(,o&tA 1} State r (f Zip cj2(,5j Telephone F{q)4JI-6254
CONTRACTOR'S NAME/COMPANY Lic. No.a? l bS'zr i Class
Contractor's Address Contractor's E-mail Address
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City Lsi.vvA t`4,cL,;_z� State 426-r1 ZIP CA Telephone C9wgiicf2_yucc
SETBACKS REAR V SETBACKS FRONT / PERMIT NO.
SETBACKS LEFT U / SETBACKS RIGHT PLAN CHECK NO.
USEZONE DEVELOPMENT NO PLAN CHECK FEES$