HomeMy WebLinkAboutS2019-0073 - Permit ApplicationF N�wl�pk
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PLEASE PRINT
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WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
I1. YKUJtLL:I AUUKt ib (NOTMAILINGADDRESS)
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LOT
TRACT
2. DESCRIPTION OF WORK S Pro t
ESTIMATED $ VALUATION /2, ®00
SWIMMING POOL ❑ SPA J�gr' POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Anolicant
3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
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o(L N
CITY STATE ZIP
PHONE NO.
lun'i GQ92-625
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
P'' >04- (L� M� (RZPAJ
ADDRESS
ENGINEER'S E-MAIL ADDRESS
V ZO t 7"u S rI n7 it ✓ r.
CITY STATE ZIP
PHONE NO.
avla�e� w\ °12do7
ryrd(— 630 o0
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
No.7%0t�S$ Class 3
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
3/
Avr&G Voe$�.- \.c -
STATE ZIP
PHONE NO.
r/CITY�� p
F.a I4vt C 9 269°(
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls