HomeMy WebLinkAboutX2020-1915 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
r' CITY OF NEWPORT BEACH
BUILDING DIVISION xZ°�" HIS
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION- OF WORK / V"D b %0 L t `6 �
i f l D
�kJ� t!" �A (IV A/A -it —ESTIMATED $ VALUATION
SWIMMING POOL ❑. SPA ❑ POOL FENCING ❑ DRAINAGE ❑
Check ADorooriate box for ADDlicant
❑ 3. OWNER'S AME
LAST
FIRST
70v_X ✓1
S EY `rte
ADDRESS
OWNER'S E-MAIL ADDRESS
J'� q
1 1.r0 L/ V .
CITY
STATE
ZIP
P NO.
L m-
&
-H -ONE
7 i Y
❑ 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
� ` S GA,
S,
C
No. 4 70& 1 ro Clas!3
ADDRESS
-mac t�_
w� �,, �(
1, C-4
CONTRACTOR'S E-MAIL ADDRESS
(_ k@�-rsCL,��dsA/L-S.0
CITY
TATE
ZIP
IPHONE NO.
ILf "t
OFFICE USE ONLY
PERMIT NO.
�
v - 64 lc_ -
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls