HomeMy WebLinkAboutX2019-3755 - Permit Application4 WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
Cid 2
LEGAL DESCRIPTION
LOT 5 BLOCK TRACT 30.
■ • • • L�r7i�' / LCZ ! I&F= fora, � syp,4 ESTIMATED $ VALUATION
SWIMMING POOL 34 7W SPA RI(O-Sr POOL FENCING DRAINAGE)t
nL.....6 A.........r:4r. k.. fr . Annll^mn+
3. OWNER'S NAME LAsr FIRST
Y C.LACllSfiG
ADDRESS
OWNER'S E-MAIL AD119 DRESS
/ ,
CITY STATE ZIP
PHONL NCr
0 4. ENGINEER'S NAME FIRST
LICENSE NO.
/LAST
r �/•sr (/ //4/t/
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP V
PHONE NO.
SAA✓ PSC u Cik 42/03
5Z5./, 0
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
c� (R eS/4'( W%i��oC.���C}'�%
✓ �
No.5ZIS`AI& Class,6
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
fi u/ e(b,Iel-�-(r CC "J A4, Co, Gz
CITY STATE ZIP
PHONE NO.
(��S%t I�ICSG2 C� clLt�Z(Q
17A1-Sf7-V72 .1/l�
Z USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Farms\Pool spa appl (rev3-04).xls
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