HomeMy WebLinkAboutS2019-0087 - Permit Application4ovp
PLEASE PRINT OR TYPE
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION � ZOIC4e 013�7
1. PROJECT ADDRESS (NOT MAILING ADDRESS) 8--- -. -
11-65— FNE 444k
LEGAL DESCRIPTION
LOT BLOCK TRACT 1 ��
2. DESCRIPTION OF WORK
SWIMMING POOL P SPA
Check Appropriate box for Applicant
ESTIMATED $ VALUATION _fp, /�=
POOL FENCING DRAINAGE �}
A
3. OWNER'S NAME - LAST FIRST
X11 z
ADDRESS
OWNER'S E-MAIL ADDRESS
C b1+j
CITY, STA ZIP
PHONE NO.
4. ENGINEERS NAME LApST FIRST
LICENSE NO.
t
�ii�b1IY M
-4-ADDRES�IS -I-�, yy �j--
dI �T, 7 k\lA �1 � 0
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
6fL 6k. z� 6
PHONE NO.
5. CONTRACTO 'S NAME
BUSINESS LICENSE
STATE LICENSE
I Z fl
eta vu� ��+� �
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No. Class
ADDRESS
7/
CONT ACTOR'S E-MAILADDRESS
4 6
, q o
STATE ZIP
6�0\q I � CIC t -_7
PHONE NO.
� 0 3 �®
OFFICE USE ONLY
PERMIT NO.
V�
PLAN CHECK N0. �n w
POOL P/C FEE $ [
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls