HomeMy WebLinkAboutS2019-0122 - Permit Application(ox
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION 1j",i-A91q
CITY OF NEWPORT BEACH �v(q1q, 01"U
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D1 FnCF PRINT OR TYPE
LOT
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BLOCK
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2. DESCRIPTION OF WORK
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SWIMMING POOL Gl--' SPA � Fin DRQNAGE-�
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3. OWNER'S NAME Lasr FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
4701 S(4P�
CITY STATE ZIP
PHONE NO.
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4. ENGINEER'pS NAME LAST FIRST
4.
LICENSE NO.
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ADDRESS ENGINEER'S E-MAIL ADDRESS
1 rJ , t U STI J
STATE ZIP PHONE NO.
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5, CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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No. i'3g09/ cC�
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
yc0 SUN)ets' 15-0
CITY STATE ZIP
PHONE NO.
17'/%2lP 1913
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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