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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of Work
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OWNER'S NAME
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Owner's Address
Owner's E-mail Address d
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APPLICANT'S NAME
Last Paloovr'ch First ///?W./,y
Applicants Address
Applicant's E-mail Address
6351 INDUSTRY WAY
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City WESTMINSTER
State CA Zip 92660 Telephone (949)631-3121
ARCHITECT/DESIGNER'S NAME Last �— First I — Lic. No. F—
Architect/Designer's Address
Architect/Designer's E-mail Address
City �—
State F— Zip F_ Telephoned
ENGINEER'S NAME
Last PETROV First PLAMEN Lic. No. 66947
Engineer's Address Engineer's E-mail Address
128191 CASITAS COURT
P.PETROV@PMA-BG.COM
City LAGUNA NIGUEL
State CA Zip f92667 Telephone (714)717-7542
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CONTRACTOR'S NAME/COMPANY SWIFT SLIP AND PIER BUILDERS, INC Lic. No. 797052 Class
Contractor's Address
8351 INDUSTRY WAY
Contractor's E-mail Address
City WESTMINSTER
State CA Zip 92683 Telephone (949)631-3121
SETBACKS REAR
SETBACKS FRONT PERMIT NO. 94 AW 002
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. 10$°l, WA
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $
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