HomeMy WebLinkAboutS2019-0098 - Permit ApplicationX I0 L'{- �
N 3rd WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION Z ��
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE uuuu
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK �^ TRACT
2. DESCRIPTION OF WORK A,/C,
SWIMMING POOL ❑ SPA E,J
/
Check Aoorooriate box for Annlicant
ESTIMATED $ VALUATION ��� &C
POOL FENCING ❑ DRAINAGES
3.
OWNER'S NAME LAST
FIRST
—
OWNER'S E-MAIL ADDRESS
{IADDRESS ` /� q
f /\
CITY STATE
ZIP
PHONE NO.
jj p 0
JUL 61711 k
4.
ENGINEER'S NAME LAST
TA
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE
ZIP
PHONE NO.
9 o,5-AvS
5.
CONTRACTOR'S NAME
ll
BUSINESS LICENSE
Amm_lNo.C�
STATE LICENSE
Class23
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
P) 72>
CITY STATE
/�'f> q�-CASs
ZIP
PH NE NO.
F,) c7�--14>
OFFICE USE ONLY
PERMIT NO. Svv��
-26 , f-" 'CJ����` L 1 �'6 -
PLAN CHECK NO. 2 e%tr; ' 2-L)
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls