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Print Form Worksheet for Combo Building & Solar Permit Application o4f`roPo
F-, Comm'] R 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 F_ Fire F_ Liq F_ Landslide F -,N/A Floor Suite No
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Description of Work
Use Const Type 7
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Valuation 1
Material/Labor 'Ve
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New/Add SIF
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OWNER'S NAME Lastj OUZoUn-jo,
First nn
Owner's Address
Owners E-mail Address
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APPLICANTS NAME LastjFirst
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Applicant's Address
Applicant's E-mail Address e�'
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State
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ARCHITECT/DESIGNER'S NAME Last
First Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F_7
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ENGINEER'S NAME Last Tw
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Engineer's Address
Engineer's E-mail Address
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city State
Zipj Telephone
CONTRACTOR'SeC4 7—
NAME/COMPANY Lic. No. Class FCy
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Contractors Address
Contractor's E-mail Address
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City State
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. `$1\j
SETBACKS LEFT SETBACKS RIGHT
-7
PLAN CHECK NO, 7-0
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $