HomeMy WebLinkAboutM2019-0038 - Permit ApplicationPrint Form',"
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Worksheet for Combo Building & Solar Per��pmmmT'}mer {„�'iF�/}
Residential City of Newport Beach - Building Divisiod �+� 96 • • 6AK
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL +
FBuilding rGrading rDrainage rElec rMach rPlum Cu rdcus 10dFill
Project Address (Not mailing address) r Flood r Fire r Q1TYL i NrzWP P&T BF i 'H
X254 6Yvvi ell
Description of Work
Use F—ConstType F
Stories # Units (if Rel
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Valuation ®�
Material/Labor
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New/Add SF Remodel SF Garage/Naw/Add
OWNER'S NAME Last Y.NNOCYFirsI�i
Owner's Address Owner's E-mail Address
27.54 G yint Ko
City Ise ®4- Gh State CA ZipR7W 8 Telephone q, T71 IZI
APPLICANTS NAME Last HUNG First PACQUELYN
Applicant's Address Applicant's E-mail Address
351 INDUSTRY WAY ACQUELYN.CHUNG@SBCGLOBAL.NET
City ESTMINSTER State CALIFORPZip 92683 Telephone 9.631.3121
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designees Address Architect/Designees E-mail Address
City State I Zip r Telephonel—
ENGINEER'S NAME Last PETROV First FLTMEN Lic. N46947
Engineer's Address Engineer's E-mail Address
8191 CASITAS COURT P.PETROV@PMA-BG.COM
City LAGUNA NIGUEL StateALIFORM Zip 162677 Telephone 14.717.7542
CONTRACTOR'S NAME/COMPANYWIFT SLIP DOCK AND PIER BUILDERS, INC. Lie. No. 97052 Class A�
Contractor's Address Contractor's E-mail Address
351 INDUSTRY WAY ACQUELYN.CHUNG@SBCGLOBAL.NET
City ESTMINSTER State PZFFORN Zip F4683 Telephone 49.631.3121
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SETBACKS REAR SETBACKS FRONT PERMIT NO. ! ► Iw)! �-UO3 P
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 1 7ti i
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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