HomeMy WebLinkAboutS2019-0006 - Permit Application,4 ` P WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
�r%.w* CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (Nor MAILING ADDRESS)
2 0 24 s VTC A-60 DIV
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Q-t'5(Oc- C' !e&) I Eck
Q e Y' cel ESTIMATED $ VALUATION ^2 r,) 000
Poole '? Q e -L i S(pc-`-- y bz s-!�F
SWIMMINGPOOL`p SPA C POOL FENCING ❑ DRAINAGE ❑
Check Aoorooriate box for Aoolicant
❑ 3. OWNER'S NAME LAST FIRST
202? L -LC
ADDRESS
OWNER'S E-MAIL ADDRESS
A S),r
0 ITY STATE ZIP
c-� �266o
PHONE NO.
rl 4. ENGINEER'S NAME LAST FIRST
„�-
LICENSE NO.
� Lo51
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONT CTOR'S NAM
BUSINESS LICENSE
LICENSE
LE
�ATE
NS6� Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
N— , i
CITY STATE ZIP
PHONE NO.
:E USE ONLY
PERMIT NO. 000 b
PLAN CHECK NO. (') 1 (j,6 - Zio �0�
POOL P/C FEE $
DRAINAGE P/C FEE $ (A
Forms\Pool spa appl (rev3-04).xls 02,0\7 7 — 0-7-00S
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