HomeMy WebLinkAboutS2019-0070 - Permit Application2U 19 -00-70
" r WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
w
w CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2 ESCRIPTION OF WORK I I (00/- Re PL,- 5- MufflibukSTIMATED $ VALUATION 2 U�10
SWIMMING POOL SPA POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
❑ 3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
A/L'w j20.4 V-C4GCAl'
PHONE NO.
9"-Z7S-006-
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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No. Class
ADDRESS
2 7 t✓-
2 C��-���4�
CONTRACTOR'S E-MAIL ADDRESS
Ton<•�ti s� . «zP &ti�rs CO
D�T�," � � SST`ATE Z/IP
PHONE NO.
:E USE ONLY
PERMIT NO;
PLAN CHECK NO:
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls