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frir)e;Fotm„, Worksheet for Combo Building & Solar Permit Application
`c'o'mm'I r Residential V City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of Work
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New/Add SFF
OWNER'S NAME
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Ise I ConstType
Storiesf # Units (if Res)F—
Remodel SFGarage/New/Add Valuation $
�: � Material/La.
Last
Owner's Address —
Owner's E-mail Address
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City I
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APPLICANT'S NAME I Last rnn nn
First
Applicant's Address -
Applicants E-mail Address
city
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j State Zip (ice—' Tele on 111,
ARCHITECT/DESIGNER'S NAME
{First
Architect/Designer's Address - - Lic. No. F —
4 Architect/Designer's E-mail Address
City
t � State�—' Zip f, Telephoner�
�1 , ENGINEER'S NAME Last r
n First
Engineer's Address 1 iUUr�,y n
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CONTRACTOR'S NAME/COMPANY
Lic. No.rg�
p Telephone
OJWt6W1, `. Lic.No. t Class)
Contractor's Address g�� t� 1��
Contractor's E-mail Address
City Zip -
State �—, F--: Telephone�—
ETBACKS REAR SETBACKS FRONT ,.
PERMIT NO.
ETBACKS LEFT SETBACKS RIGHT _ PLAN CHECK NO.
;E ZONE DEVELOPMENT NO i� /fes - /�� �("y^�
�1`� ��•-->•4i�'L./ PLAN CHECK FEES $