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Print Form Worket for Combo Building & Solar Permit Applica
F Comm'I `q1 Residential / City of Newport Beach - Building Division
I7 NOT PLAN CHECK FEES DUE AT TIME OF SUBMIT BLICj
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HARgO PERMIT
Project Address (Not mailing address) r Flood r Fir i (— Landslide FN/A Floor
1150 ?b\(,(Y �tr ��
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Description of Work
Use F—Const Type
�IbVL LUVLG� 2 t(�c C�
# StoriesF # Units (if Res)F
Valuation $ I 1
Material/Labor-
New/Add 5F� Remodel SF�—
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Garage/New/Add I —
OWNER'S NAME Last1
First tjgOUy, p,
O Address
Owner's E-mail Address
ywner's
16 Jam% `r o Yl S
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City bmuGi State Feiq zip `72(eieo Telephon 'i.-(p31-wvs-
APPLICANT'S NAME Last CHUNG
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First ACQUELYN ���qq//����
Applicant's Address
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Applicant's E-mail Address 11 \ —
351 INDUSTRY WAY
JACQUELYN.CHUNG@SBCGLOBAL.NET
City ESTMINSTER State CALIFORI`
Zip 92683 Telephone 49.631.3121
ARCHITECT/DESIGNER'S NAME Last Fired Lic. No.
Architect/Designees Address
Architect/Designees E-mail Address
City I State �—
ZIP r Telephonel—
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 ILAGUNA NIGUEL State CALIF0R�
Zip 2677 Telephone 714.717.7542
CONTRACTOR'S NAME/COMPANY ISWIFT 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 ALIFORh
ZIP F4683 Telephone 49.631.3121
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. %,
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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