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Print Form_ Worksheet for Combo Building & Solar Permit Application o���W`°Rr
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F_ Comm'I F Residential City of Newport Beach - Building Division ` 1�
\ NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (64ot mailing address) C Flood f7 Fire f— Liq F_ Landslid Floor Suite No
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Description of Work
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# Storifsl # Units (if ReF)�
Valuation
Material/Labor
New/Add SF �Z �6 Remodel SF I Garage/New/Add �
OWNER'S NAME Last h�,,� First G ----
Owner's Address Owner's E-mail Address
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City I- -h se,G' L. State e b�- Zip 1. Telephone
APPLICANT'S NAME First �p
Last ?U � 'i 4-U ,J U S ,�
Applicant's Address Applicant's E-mail Address
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City State Zip Z (,61 Telephonee 1 • _y j 716
ARCHITECT/DESIGNER'S NAME
Last � h � � (� P �' First l s V j v ti t' t= Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City L, c k e "r 5 l State ( Zip Z0 Telephone I 7-Z 0r; "f
ENGINEER'S NAME Last First Lic. No.
Engineer's Address Engineer's E-mail Address
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City I All 1.5 5( v_PV U C) State Zip Z ('92 Telephone
CONTRACTOR'S NAME/COMPANY S ` Lic. No. g lass
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Contractor's Address Contractor's E-mail Address
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City 1 yV(2-tr }00V-1_ State I C. A Zip TelephoneF(j q C1,3I._/ 9 G
SETBACKS REAR SETBACKS FRONT PERMIT N •'�' I V r
SETBACKS LEFT SETBACKS RIGHT PLAN CHE NO.
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USE ZONE DEVELOPMENT NO PLAN CHECK FEES $