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HomeMy WebLinkAboutS2019-0088 - Permit ApplicationSIM- DD" Nrwro WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION CITY OF NEWPORT BEACH BUILDING DIVISION PLEASE PRINT OR TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) 1915 LEGAL DESCRIPTION LOT BLOCK TRACT 2. DESCRIPTION OF WORK (©o)- Q,-,2 SWIMMING POOL )�3' SPA Check Appropriate box for Applicant ESTIMATED $ VALUATION �c( C,C!J POOL FENCING ❑ DRAINAGE ❑ 3. OWNER'S NAME LAST FIRST SfiCv�F'-usH ADDRESS 4 OWNER'S E-MAIL ADDRESS CITY STATE ZIP^ z,ov-, u4 �� �� �� CSF °�zlsz 5 PHONE NO. ��� ��z -©��s 4. ENGINEER'S NAME LAST FIRST LICENSE NO. er ADDRESS ENGINEER'S E-MAIL ADDRESS CITY STATE —7F--7 HONE NO. 5. CONTRACTOR'S NAME / 1 W W S M (Wkl �c�/'s BUSINESS LICENSE ATE LICENSE Nos %w%g6 Class ADDRESS -2-2-LV Z -4R Z 5—Te CONTRACTOR'S E-MAIL ADDRESS' CIT STATE ZIP PHONE NO. OFFICE USE ONLY " PERMIT NO. S PLAN CHECK NO. POOL P/C FEE $ DRAINAGE P/C FEE $ Forms\Pool spa appl (rev3-04).xls