HomeMy WebLinkAboutS2019-0037 - Permit Applicationozl,
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
(NOT MAILING ADDRESS)
LOT BLOCK TRACT
f#1:61CvIiILCLEel 3TiffifT:73
( )0"L-
- 1 .1
to
0"L-
to X';S -3s'y ESTIMATED $ VALUATION ✓U z'
SWIMMING POOL SPA POOL FENCING I DRAINAGE �
Check Amrooriate box for Aoolicant
3. OWNER'S NAME LAST FIRST
w
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
Cw Orr Z04--vc, C4 ek
4. ENGINEER'S NAME LAST FIRST
LICEN NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
e- I'D
No.307S 3�'Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
Cl Y STATE ZIP
PHONE NO.
s'J=73x2
-E USE ONLY
PERMIT NO. 6103-
q n r—
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls