HomeMy WebLinkAboutX2019-3641 - Permit Application';Pnntorin,;. Worksheet for Combo Building & Solar Permit Application
( Comm'I (X; Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F -:,Building 17 Grading (-Drainage [7 Elec r-IMech Plum CuvdCut �; Cu
vdrill F,
Project Address (Not mailing address) F. Flood F Fire F,-, Liq j- Landslide FN/A Floor Suite No
500 Roxbury
Description of Work
22 L.F. ofTemporary5l
New/AddSFF RemodelSFF Garage/New/Add
OWNER'S NAME Last
Owner's Address
First
Owner's E-mail Address
Use Const Type
# StoriesF # Units (if Res) -
Valuation $ 30000
Material/Labor '
500 ROXBURY RD
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City NEWPORT BEACH State CA Zip F— Telephonel—
APPLICANT'S NAME Last
Applicant's Address
900 BRISTOL ST, BLDG A, SUITE 203
City COSTA MESA State CA
ARCHITECT/DESIGNER'S NAME Last
Architect/Designer's Address
City State f
First
Applicant's E-mail Address
MTEALE@TEALEARCH ITECTURE. COM
Zip P2626 Telephone 949-975-0123
First MARK Lic. No. 22162
Architect/Designer's E-mail Address
Zip �— Telephoned
ENGINEER'S NAME Last RAN First JOHN Lic. No. 62653
Engineer's Address
14371 EUCLID ST #2F
City GARDEN GROVE State CA
Engineer's E-mail Address
DTRAN07@GMAIL.COM
Zip92843 Telephone714-815-2356
- --
CONTRACTOR'S NAME/COMPANY Lic No. Class F_
Contractor's Address
City �— State F—
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Contractor's E-mail Address
Zip F Telephone
PERMIT NO. i1,414M U41
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $