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Worksheet for Combo Building & Solar Permit Application
j- Comm'I [_ Residential
NOTE:
City of Newport Beach - Building Division �_1/k ,b-09';I/
PLAN CHECK FEES DUE AT TIME OF SUBMITTA U
r Building j` Grading j-'Drainage j— Elec F_ Mech
Plum Cu Yd Cut Cu vd Fill
Project Address (Not mailing address) F_ Flood
(— Fire r Liq [71 Landslide rN/A Floor Suite No
Description of Work
Use Const TypeF / ,
# StoriesF # Units (if Res)[ —
Valuation $
Material/Labor i Q��
New/Add SFr Remodel SF I Garage/New/Add ��
OWNER'S NAME Last .�� - , First
Owner's Address
Owner's E-mail Address
7
City State FT t/4
Zip `7 Z66 O Telephone)
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City State ��
--
Zip Telephone
t1 ARCH ITECT/DESIGNER'S NAME Last
First Lic. No. �— J
Architect/Designees Address
Architect/Designer's E-mail Address
'
----------------,.--
� State
City �;sw� \/v ., C C�
Zi Telephone .J (c ( _
p %1�5� (0l7'631Cn
ENGINEER'S NAME Last First I `Lic. No.1 C Z�
Engineer's Address
Engineer's E-mail Address
L�2 2� Can_--► ----'.
City �5 T� State
Zip Telephone `*L-5,-y,_—*6-) �
CONTRACTOR'S NAME/COMPANY / / Lic. No. � Class
Contractor's Address
Con/tractor's E-mail Address
1
05 h v i Id 40
City State (' <.
Zip 1 c j -2 �. (�� $ Telephone "" q,
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $