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HomeMy WebLinkAboutM2019-0066 - Permit ApplicationPrint Form °; Worksheet for Combo Building & Solar Permit Application �� YYI�i01�1 0L b City of Newport Beach- Building Division PUBLIC WOR r Comm Iiesidentia NOTE; PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 1. jBullding r Grading rDrainage r Elec F Mech F Plum cuvdcutj HA 8QffPMMIT Project Address (Not mailing address) f Flood r Fire r Uq I r 5 (f 40 0 . to , A4 . � `�l 63 Description of Work Use ConstType F_ Lees- GjV-A # Storiesf— # Units (if Res)[— Valuation $;2©`bo Materll9l/kabor t New/Add SFr r Remodel 5F�— Garage/New/Addl OWNER'S NAME Last First �cxviF Owner's Address Owner's E-mail Address �� 11,40 - U W J yCly City at A� BM-- State � Zip 21(0(V( Telephone 9•c0.3i 3121 APPLICANT'S NAME Last HUNG First PACQUELYN Applicant's Address Applicant's E-mail Address 351 INDUSTRY WAY ACQUELYN.CHUNG@SBCGLOBAL.NET City ESTMINSTER State CALIFORh Zip 92683 Telephone 49.631.3121 ARCHITECT/DESI¢NER'S NAME Last First �— Lic. No. �— Archlt oar's Address ArchitecUDesigner's E-mail Address City State F Zip I TelephoneF ENGINEER'S NAME Last PETROV First PLAMEN Lic. No. 6947 Engineer's Address Engineer's E-mail Address 8191 CASITAS COURT P.PETROV@RMA-BG.COM City LAGUNA NIGUEL State CALIFORh Zip 2677 Telephone 714.717.7542 CONTRACTOR'S NAME/COMPANY WIFT SLIP DOCK AND PIER BUILDERS, INC. Lic. No. 97052 Classf' Contractor's Address Contractor's E-mail Address 351 INDUSTRY WAY ACQUELYN.CHUNG@SBCGLOBAL.NET City ESTMINSTER State FALIFCRPzip 2683 Telephone 49.631 .3121 SETBACKS REAR SETBACKS FRONT PERMIT NO. SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ l,'7