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Worksheet for Combo Building & Solar Permit Application
F- Comm'I F_ Residential City of Newport Beach - Building Division
NOTE' PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[-Building Grading
F -Drainage F_Elec r-Mech F_Plum Cu Ydcut[— Cu Yd FillF—
Project Address (Not mailing address) F_ Flood F_ Fire F_ Liq Landslide [N/A Floor Suite No
Description of Work
Use F_ Const Type F
# StoriesF_ # Units (if Res)F—
Valuation S p
Material/Labor V D V
New/Add SF)
Remodel SFGarage/New/Add
OWNER'S NAME
Last First I
Owner's Address
Owner's E-mail Address
City
State I Zip F— TelephoneF—
APPLICANTS NAME
Last First
Applicant's Address
Applicants E-mail Address
City
State F— Zip F TelephoneF_
ARCHITECT/DESIGNER'S NAME Last First Fi Lic. No.
ArchitecUDesigners Address
ArchitecUDesigners E-mail Address
city
State w— Zip ! Telephone
ENGINEER'S NAME
Last (� First lj2 G Y[�'1- Lic No.
Engineers Address
E ineers E-mail Address ,
Zn w
City
G Zip 1 T��
-
CONTRACTOR'S NAME/COMPANY ( Lic. No. I Class
Contractors Address
Contractor's E-mail Address
City
I
State Zip Telephoned
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
C
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
L Worksheet for Combo Building & Solar Permit Application ��"° e
(- Comm" (/wesidential City of Newport Beach -Building Division x2m i, -022'jl
I/ NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI AL
lv�uilding r Grading j -Drainage ( Elec F-Mech F- Plum CuvdCut F_ cuvdFill F_
Project Address (Not mailing
address) F- Flood I- Fire F- Liq F- Landslide [N/A Floor Suite No
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Description of Work
Use r- Const Type r_
# Stories # Units (if Res)F—
u
ff
L
?
Jr
11
eI
New/Add SFr— Remo SF�'�-- — Garage/New/Add
Valuation 5
Material/Labor
OWNER'S NAME Last
First IVA
Owner's Address
Owner's E-mail Address
/ /—,�y
/ -� 'd'��
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�J_n�—V�
City I /t 5_
_ _ State CGG'� Zip�26, M Telephon 7/'fYVy�L2V
APPLICANT'S NAME Last
C 76/woov First
Applicant's Address
Applicant's E-mail Address
S,q�P
lJ 'x' 03 n /-
--
77<;�2
City rl%
State . Zip " -;-� Telephoner 370K--
ARCHITECT/DESIGNER'S NAME
Last First is --- Lic No. r--
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �— Zip Telephoner—
ENGINEER'S NAMEr—
Last
First Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City i
State I Zip -s- Telephoner---.-.-_—
CONTRACTOR'S NAME/COMPANY
+ Lic No. r— -- Class r'
`Contractor's Address
Contractor's E-mail Address
r�
/
State rZip r---- Telephone
CKS REAR
SETBACKS FRONT PERMIT NO. 1O"'
KS LEFT
SETBACKS RIGHT PLAN CHECK NO. / �p
E
DEVELOPMENT NO PLAN CHECK FEES $ ��