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HomeMy WebLinkAboutS2019-0083 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION e$ CITY OF NEWPORT BEACH BUILDING DIVISION r�cF+ac rnuxi mm I rrc F77M7ECT ADDRESS (NOT MAILING ADDRESS) S- kf�4LF MooN 131441 ue LOT TRACT 2. DESCRIPTION tWORK (\L �I�S�Q �o aj &-r +fir y �Ad� ESTIMATED $ VALUATION ? ©0 a, SWIMMING POOLS SPAP POOL FENCING ❑ DRAINAGE ❑ Check Aoorooriate box for Anolicant El 3. OWNER'S NAME FIRST /LAST AL F�fr ADDRESS OWNER'S E-MAIL ADDRESS r \ � �7 J �z 4 ( rt- 1 " I OU`! iii' de CITY STATE ZIP PHONE NO. 7� 4. ENGINEER'S NAME LAST FIRST LICENSE NO. ADDRESS ENGINEER'S E-MAIL ADDRESS CITY STATE ZIP PHONE NO. 5. CONTRACTOR'S NAME v / ��vr� BUSINESS LICENSE 5- 7 r /9 6 STATE LICENSE C 1 No. Class - ADDRESS CONTRACTOR'S E-MAIL ADDRESS 2z7 w. C(�f�1 i/[i CITY STATE ZIP 14mi L i�Qf 0200, PHONE NO. `(9;7 —8339 :E USE ONLY PERMIT NO. PLAN CHECK NO, POOL P/C FEE $ DRAINAGE P/C FEE $ Forms\Pool spa appl (rev3-04).xis