HomeMy WebLinkAboutS2019-0012 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
Z01q> ®®I 2 CITY OF NEWPORT BEACH `�
BUILDING DIVISION
PLEASE PP
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
( q27 P t4P
LEGAL DESCRIPTION
LOT BLOCK
TRACT
2. DESCRIPTION OF WORK ;%i- if 5?r 7#of
645 ` 56P , FlKE P1 r ESTIMATED $ VALUATION
SWIMMING POOL I' SPA ff/ RGGI GING El
Check Appropriate box for Applicant
LPL-�0
3. OWNER'S NAME LAST FIRST
SAM so &/
ADDRESS
l 92-7 e"`1f#9
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
(v ople- Df?" 419fZ C� 9;-,&x
56Z Col e47/
4. ENGINEER'S NAM LAST FIRST
10, . G
LICENSE NO.
-7zlao3
el"ba-k 's,
ADDRESS
ENGINEER'S E-MAIL ADDRESS
7,0( -M-57-1/4
CITY STATE ZIPPHONE
Ano, 6 5�7
NO.
l711/006100
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
?00
No. ClJW-
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIPPHONE
ct,�i�� Gay 9ZG7
NO.
�yf yqL IGS
CE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Farms\Pool spa appl (rev3-04).xls
t:) g2,•'Lc�1`
l CzL9g 11 , J�P,-Ib-G1 J