HomeMy WebLinkAboutX2019-3640 - Permit ApplicationPrint Form
Worksheet for Combo Building & Solar Permit Application
F- Comm'I ix Residential City of Newport Beach - Building Division a
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL °<,•aa "
r -Building r Grading
r -Drainage r Elec r Mech r- Plum Cu Yd Cut Cu Yd Fill F
Project Address (Not mailing address) F Flood r Fire r- Liq I-'- Landslide rN/A Floor Suite No
4500 Roxbury I ( —
Description of Work
t,r �� -`fes rn `i
Use F—Const Type
# Stories[— # Units (if Res)F_
Valuation $ FO, 000
New/Add SF
Remodel SF�— Garage/New/Add�Material/Labor
OWNER'S NAME
Last ROSHAN First KASARA
Owner's Address
Owner's E-mail Address
4500 ROXBURY RD
City NEWPORT BEACH
State Zip F_TelephoneF_
APPLICANT'S NAME
Last TEALE First MARK
Applicant's Address
Applicant's E-mail Address
2900 BRISTOL ST., BLDG A, SUITE 203 mteale@tealearchitecture.com
City COSTA MESA
State CA Zip 92626 Telephone (949) 975-0123
ARCHITECT/DESIGNER'S NAME Last TEALE First MARK Lic. No. JC52162
Architect/Designer's Address
Architect/Designer's E-mail Address
City I_
State F_ zip F_ Telephoner—
ENGINEER'S NAME
Last PATEL First SHARAD Lic. No. 5-4488
Engineer's Address
Engineer's E-mail Address
ispatel@pbastructural.com
City 9283 RESEARCH DRIVE State IRVINE Zip 92618 Telephone (949) 943-8080
CONTRACTOR'S NAME/COMPANY Lic. No. F— Class F_
Contractor's Address
Contractor's E-mail Address
City
State I Zip I Telephone[
SETBACKS REAR
SETBACKS FRONT PERMIT NO,
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $