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HomeMy WebLinkAboutS2019-0071 - Permit ApplicationS2 -0[q ® 0011 WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION CITY OF NEWPORT BEACH BUILDING DIVISION PLEASE PRINT OR TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) LEGAL DESCRIPTION LOT BLOCK TRACT 2. DESCRIPTION OF WORK IC)O( I Si'UI ��j ( /� , �LIAYer 8/9 I [ p f'J s4oy) Q �Z W 19 Sf eA CITY STATE ZIP ESTIMATED $ VALUATION ' � 4. ENGINEER'S NAME LAST FIRST SWIMMING POOL E SPA Ef- POOL FENCING ❑ DRAINAGE ❑ Check Aoorooriate box for Annlicant 3. OWNER'S NAME LAST FIRST �L9G111 H 2(- arl{/_5 i Gi� ADDRESS - OWNER'S E-MAIL ADDRESS S �ivl CITY STATE ZIP PHONE NO. Q,rd'14 C A- I Zv zc— 4. ENGINEER'S NAME LAST FIRST LICENSE NO. QGln (,CCLj42,r C-7lf003 ADDRESS ENGINEER'S E-MAIL ADDRESS ltd 1 014- 1 CITY STATE ZIP PHONE NO. M14^ G/l T -716( (,3©.6(00 5. CONTRACTOR'S NAME BUSINESS LICENSE STATE LICENSE S�OULA �GO 1�Vj No.(OZOt/Clafij;S ADDRESS CONTRACTOR'S E-MAIL ADDRESS CITY STATE ZIP 6s&— -?7�7 PHONE NO. (f 1141 /'9._ 5Zy'f3�, :E USE ONLY PERMIT NO. PLAN CHECK NO. POOL P/C FEE $ DRAINAGE P/C FEE $ Forms\Pool spa appl (rev3-04).xls 01365 --?-v 15