HomeMy WebLinkAboutS2019-0052 - Permit ApplicationS2-0tq - o0l;2-
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION Vey
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
Z� �) '-D/2-
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK �
3 ESTIMATED $ VALUATION I vee
SWtMMiidla-P06t-"e1 SPA POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
r�b1 Cp,+sT C-
PHONE NO.
�i � t--7i� l l3 2
4. ENGINEER'S NA""�}E ii LAST FIRST
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LICENSE NO.
-7q003
rol�c�
ADDRESS
ENGINEER'S E-MAIL ADDRESS
c 0Q
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME n! n
BUSINESS LICENSE STATE LICENSE
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I 11I (00C •- 5�%i
NoUq� i �D Class
ADDRESS
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CONTRACTOR'S E-MAIL ADDRESS
CITY TATE /TATE ZIP
( 4esA `
PHONE NO.
�y S7 3 4,?
?�74 L z 62 7
b
:E USE ONLY
PERMIT NO. �32of 9, _
PLAN CHECK NO. -� l
POOL P/C FEE $ ..---
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls