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Print Form Worksheet for Combo Building & Solar Permit Application
[- Comm'I(� Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) (— Flood [- Fire [- Liq V f'r/PERMIT Suite No
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Description of Work
Use /Const Type F_
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#Stories #Units (if Res)
Valuation $
Material/Labor I IJIJO
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New/Add SF F—Remodel SF I— Garage/New/Add �—
OWNER'S NAME Last ryS First �psh
Owner'sOwner's E-mail Address
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City WoFriGa' State I L r( Zip Telephone ZV`z7j3.. /(p3
APPLICANT'S NAME Last CHUNG First ACQUELYN
Applicant's Address Applicant's E-mail Address
6351 INDUSTRY WAY ACQUELYN.CHUNG@SBCGLOBAL.NET
City ESTMINSTER State CALIFORI` Zip 92683 Telephone949.631.3121
ARCHITECT/DESIGNER'S NAME Last First F Lic. No.I
Architect/Designer's Address Architect/Designer's E-mail Address
City State F_ Zip F Telephone�—
ENGINEER'S NAME Last PETROV First PLAMEN Lic. No. 6947
Engineer's Address Engineer's E-mail Address
8191 CASITAS COURT P.PETROV@PMA-BG.COM
City LAGUNANIGUEL . State CALIFORN Zip F2677 Telephone714.717.7542
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 FALIFORNzip 2683 Telephone 949.631.3112,1,
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 0-76"S -10 d
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $