HomeMy WebLinkAboutS2020-0181 - Permit ApplicationS2-07,0 04.`
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
16 1-z- -(fl 6� /-16
LEGAL DESCRIPTION
LOT BLOCK TRACT / .rs 2--
2. DESCRIPTION OF WORK WCVJ �Obl Z�� �� x
-}- �` C ( t b>rcl ESTIMATED $ VALUATION SC�',ev107>
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SWIMMING POOL ®,-- SPA ®�-' POOL FENCING ❑ DRAINAGE
Check Aoorooriate box for Annlicant
3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
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(-t L, i)`
CITY STATE ZIP
PHONE NO.
N) -,,r3 0 4�-
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4. ENGINEER'S NAME LAST FIRST
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LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
(7c) i N s—F1 Ale -
CITY STATEZIP
00erl 0 ( vv\ CA- 9z -3r
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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No.���O��Class��
ADDRESS
CONTRACTOR'SE-MALADDRESS
CITY STATE ZIP
Irc em- 10G5
PHONE NO.
SbZ-Zo0��sS62
:E USE ONLY q_
PERMIT NO. 'Sul'o"n5i5l0%.flnn'1p� �2U121 • b�j�+1 "�%1
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls