HomeMy WebLinkAboutS2019-0163 - Permit Application04 bm
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PLEASE PRINT OF
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WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
1. rUJtU I AUURLSS (NOT MAILING ADDRESS)
5 5 �- �J �-►�1 E5 `ice
BLOCK
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATION
SWIMMING POOL E?-' SPA Q --PppL-FEN ;a,_,0
Check Awrooriate box for Annlicant
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w' . o
ER'S NAME LAST FIRST
RESS
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rECI
OWNER'S E-MAIL ADDRESS
T , STATEZIP
PHONE NO.
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7/�(3IS
4. ENGINEER'S NAME LAST FIRST
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LICENSE NO.
6-7(aS-Tr�,
ADDRESS
ENGINEER'S E-MAIL ADDRESS
tit l�. `USIf�
CITYh�ul� STATE q2,�07ZIP
PHON NO.
5. COON(TRRA/CTOR'S NAME
BUSINESS LICENSE STx/AT�jE LICENSE
ARIESS � � � r
CONTRACTOR'S E-MAIL ADDRESS
CIT � STATE
P� � NO.
:E USE ONLY
PERMIT NO.
PLAN CHECK NO. 09tolC $%* tat
POOL P/C FEE $
DRAINAGE P/C FEE $
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