HomeMy WebLinkAboutX2020-2857 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH L?'S7'7
BUILDING DIVISION X!
VILLA= YKINi VK 1TYC
.1. PROJECT ADDRESS (NOT MAILING ADDRESS)
1'31 fin , ,oa (k-) a
LEGAL DESCRIPTION
BLOCK 38 `J -,2 TRACT ! V
2. DESCRIPTION OF WORK Cx 11( i pnr,
n e - r Lr p Ian
—F -r -A �L 9/n_'Vl , now liJ n% &)ce ESTIMATED $ VALUATIONeNi zfjo
SWIMMING POOL I9 SPA g POOL FENCING I0 DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
Chen Pdd,e
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
New orf Beoch, cil 91 (--6 U
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS - -
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
PRCC)nS�roC-17t)n
Oi 30yaS63
No. 5GISl S Class-
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
//5- 15� P'(-iX0
vrn �@• Ur/�ICS l I'
CITY STATE ZIP
PHONE NO.
b' /e dor, C�! �/ 7L/L�
6�6- 9b5 3o y
:E USE ONLY
PERMIT NO.
PLAN CHECK NO. .(
POOL PIC FEE $
DRAINAGE PIC FEE $
Forms\Pool spa appl (rev3-04).xls