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Worksheet for Combo Building & Solar Permit Application
F_ Comm'I F Residential Gay of Newport Beach - Building Division )C2022 _ I1�"j �(�,&
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �� 11
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Building j ` Grading r ;Drainage F_, Elec r Mech
J Plum Cu Yd Cut F
Cu Yd Fill F
Project Address (Not mailing address) F_ Flood r— Fire f— Liq � Landslide F_N/A Floor Suite No
Owner's Address Owner's E-mail Address
City l.h�l wsl �11.'l �� i State I C 1 1 Zip _ Telephoned
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
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City tn' R4 L4�j State I� Zi 1s Telephone t, c-26
ARCHITECT/DESIGNER'S NAME VA
Last 0 1 A _ First l Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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\ (..._ i / Lev t S�{ur tic, i� e fi-� Ire c uVh
City I ��� �1 CSC V State Cam` Zi
I� > p 9W0. Telephone -6 �'� J am[
CONTRACTOR'S NAME/COMPANY
. _(%X Lic. No. Class .F
Contractor's Address Contractor's E-mail Address
L , 1 CCU (orc AC) 1k -C__
City ..u!�1�� C� 1� State F51k7 Zip �1 2- j� Telephone M - 4(D5" v2—
SETBACKS REAR
SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO. " vL-
PLAN CHECK Nd.
PLAN CHECK FEES $