HomeMy WebLinkAboutS2019-0112 - Permit Applicationfigwvn8
u W
C�41IOO��T
PLEASE PF
LOT
�2o0 m oar 2 -
WORKSHEET
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
TYPE
KESS (NOT MAILING ADDRESS)
L:1 / S L!O6--hA"
2. DESCRIPTION OF
BLOCK
L E
TRACT
$ VALUATION 4 J O
SWIMMING POOL L;I SPA Lys -RO01 FFnIr.INr ❑ 9PA'^,o�:AGE--E:1
Check Appropriate box for Applicant
3. OWNpE�R'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
q. 5 ) 5 eW-ht4k"
CITY STATE ZIP
PHONE NO.
C'pm a s2 -4,,2
9'&Z -AIA 7/
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
GG%2✓ // 0)�j7
07fa;7o
ADDRESS
ENGINEER'S E-MAIL ADDRESS
I�1 �I.��v�
CITY STATE ZIP
PHONE NO.
G
A464p„� v- CU IZ0a7
1714&-3D6ICD(:5
5. CONTRACTOR'S NA3�eef(�
BUSINESS LICENSE
STCATE LICENSE�Ke'.
No. 1231[7 Class
ADDRESS
CONTRACTOR'S E-MAILADDRESS
`-�y Ltd
CITY STATE ZIP
a? C4 q`7>-3-67
PHONE NO.
1, y ask I �L7
Z USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
'4-]:” 2oLE-1