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orm Worksheet for Combo Building & Solar Permit Application
Comml F— Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F—_Building 17Grading C�Hrainage F-Elec F—bMech &plum CuYdCut
Cu Yd Fill
Project Address (Not mailing address) F- Flood F- Fire F- Liq F— Landslide _N/A Floor Suite No
Description of Work —14 � E:r j d tf U c 7, Oj c L,
Use ConstType
^ GR �F # Stories # Units (if Res)
_-__ 1_N�_> Q ri/N[�S/ - Wes+ -
New/Add SF� O Remodel SF f Q Garage/New/Add �— Valuation $ 1119
____ Material/Labor 00 f OA Q.i
OWNER'S NAME
LastT . N4k. J
----
wner's Address —
Owner's E-mail Address
city p6aT C state
— .-- — -- __ - ZIP 7149464 Telephone W7_, /4 Ad
APPLICANT'S NAME Last
V RUIV/ T� Applicant's
�14 4.N
Applicant's Address �J — licant's E-mail Address
City — _ --- F X=6 / P
_ /�w/1�jQ / �h�t� State G^ ZiP Tele hone
ARCHITECT/DESIGNER'S NAME Last r / ^ �"�—
LGGGh� — First Lic. No. C.
Architect/Designer's Address —'z
�q r4�• Architect/Designer's E-mail Address
q
y —� �//G__/9 — -- State 7 l� /$ZiP Telephone
City
ENGINEER'S NAME Last —
VG'_ C N6. First F7777— _ Lic. No.r--
Engineer's Address Engineer's E-mail Address
--.r'P r7rf ✓aN -Gage✓•
City a
A Vill-e- State _ Zip ado ,Telephone f Yf •_ `l7y �9la
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractor's Address Contractor's E-mail Address
City State �— Zip Telephone 6 26
� � ,% 'Yo,- yg�1. cur
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO L i
USE ZONE DEVELOPMENT NO 11
PLAN CHECK FEES ES