HomeMy WebLinkAboutS2020-0085 - Permit ApplicationriieP" WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
BUILDING DIVISION `�Zcj Z1 (/CEJ
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS
(NOT MAILING ADDRESS)
/
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK —'MSI
SWIMMING POOL ❑ SPANf
Check ADDronriate box for Annlirant
_ ESTIMATED $ VALUATION zt DO e
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
J-05�
ADDRESS
OWNER'S E-MAIL ADDRESS
7 J-�e trr`�
CITY STATE ZIP
CA �fzao
PHONE NO.
9Y2 -739- 131V
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME1
BUSINESS LICENSE
STATE LICENSE
�% /
5 �O L�
7� F '
5)
No. CCs
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
C4 9z.K �>
2 c j -3 s 3-,-ar"p Z
:E USE ONLY
PERMIT NO. l S ,z -U zo — 00,10S
PLAN CHECK NO. I `� �. C iD17- 0
POOL P/C FEE $
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