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Worksheet for Combo Building & Solar Permit Application
r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F -Building -Grading F–Drainage rElec F–Mech
F–PlumCu Yd Cut Cu Yd Fill
Project Address (Not mailing address) f- Flood
F– Fire F– Uq r– Landslide rN/A Floor Suite Ni
Description of Work
Use F_ Const Type F_
v
-
# Stories Z # Units (if Res)r
Valuation $ p
Material/Labor I l
New/Add SFF— Remodel SF� Garage/New/Add �—
OWNER'S NAME LastW�C�f%v Sr First
Owner's Address H D
Owner's E-mail Address
City _ _ State
Zip F Telephoned D /1S
APPLICANTS NAME LastwW t Ldr
First �YJCod).S
Applicants Address
Applicant's E-mail Address _
ILV
City y in State F
Zip 9 Telephone `7� /. � 0r
F K
ARCHITECT/DESIGNER'S NAME Last I
First Lic. No. �—
Architect/Designer's Address
Architect(Designer's E-mail Address
City State �—
Zip �— Telephonel—
ENGINEER'S NAME Last ,}� i P� FirstQ(� I W 6- Lic. No.r �
vv ---mail
Engineer's Address
Engineer's E Address
i5 0 (;!->RO0 .4, 141)1 ONAl W
city t o S tr�/fa State j
ZIP 1 �Z� % 02S Telephone �J i k 6L 2 6 s; Q
CONTRACTOR'SNAMEICOMPANY N&,Ug ��i' Lic. No. &1-24/. 0 Class
�!*
Contractor's Address
Contractor's E-mail Address
City ... y j ry State ' l ` v -
Zip 17 Telephone ,7/(Y 1(.?/
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO — PLAN CHECK FEES $