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HomeMy WebLinkAboutX2019-0065 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION 0803-.2(919 \ x2ot9-0065 J a CITY OF NEWPORT BEACH 4 H� BUILDING DIVISION PLEASE PRINT OR TYPE _Ci \� 7 -- CJ ck S 1. PROJECT ADDRESS (NOT MAILING ADDRESS) 1 2 sA/,-,[A LEGAL DESCRIPTION LOT BLOCK TRACT 2. DESCRIPTION OF WORKN A 5 6 Q S CWq 811JL-, �� S©• �r• 6} us T- L "PSTI ATED $ VALUATION SWIMMING POOL ® SPAPOOL FENCING ❑ DRAINAGE ❑ Check Aw3roariate box for Anolicant Fj 3. OWNER'S NAME LAST FIRST C)H Aj co ADDRESS OWNER'S E-MAIL ADDRESS LI -2-q s c--/ T CITY STATE ZIP PHONE NO. 4. ENGINEER'S NAME LAST FIRST LICE SE NO. A � t0� � / � 76-S V ADDRESS ENGINEER'S E-MAIL ADDRESS CITY STATE ZIP PHONE NO. 5. CONTRACTOR'S NAME BUSINESS LICENSE STATE LICENSE 612 �' o. No. Class ADDRESS CONTRACTOR'S E-MAIL ADDRESS iOck idof•,c. CITY STATE ZIP PHONE NO. OR -AN 6,S CA- 3Z 3 -WA --1 �'2 :E USE ONLY PERMIT NO. SLol `lj� PLAN CHECK NO. O C?)v - POOL P/C FEE $ w DRAINAGE P/C FEE $ Forms\Pool spa appl (rev3-04).xls