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HomeMy WebLinkAboutS2019-0111 - Permit Application11151-V6 0Q.," WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION C�C)jL7'Ol/1 CITY OF NEWPORT BEACH BUILDING DIVISION PLEASE PRINT OR TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) tO �PW. Cw,q LEGAL DESCRIPTION LOT BLOCK TRACT 2. DESCRIPTION OF WORK SWIMMING POOL)< SPA Check Appropriate box for Applicant ESTIMATED $ VALUATION 9 , — POOL FENCING ❑ DRAINAGE ❑ 3. OWNER'S NAME LAST FIRST `f -G ADDRESS jWN'E-MAILADDRESS D v-- ,Y4 U'1. I eL je C .co wt CITY I I STATE 04 - l�� PHONE E NO. _ . W ; � 4. ENGINEER'S NAME LAST FIRST LICENSE NO. ADDRESS ENGINEER'S E-MAIL ADDRESS CITY STATE ZIP PHONE NO. 5. CONTRACTOR'S NAME S BUSINESS LICENSE STATTEE LICENSE o. 6 — ?) Clas ADDR SS E-MAIL ADDRESS (CONTRACTORS LOA (111, q STATE ZIP Qkf-ewlp PHON L ,5(-)D D©D OFFICE USE ONLY PERMIT NO. PLAN CHECK NO. I l POOL P/C FEE $ DRAINAGE P/C FEE $ Forms\Pool spa appl (mv3-04).xls