HomeMy WebLinkAboutS2020-0174 - Permit ApplicationNr WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION �p
CITY OF NEWPORT BEACH
SE BUILDING DIVISION
PLEASE PRINT OR TYPE
Ft. PROJECT ADDRESS (NOT MAILING ADDRESS)
'o(V _I-
1110111
BLOCK
2. DESCRIPTION OF WORK Ld'nJ74Q (
Y5/112 4J S4,L Q ae- e6
SWIMMING POOL SPA/ [
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Check Awrooriate box for Annlican`t
)
H ca au ItESTIMATED $ VALUATION �S-Z), 000
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
ADDRESS
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OWNER'S E-MAIL ADDRESS
;lam- �—
���ru� � w"It a)(('i, ectvi
CITY STATzipE
ONE NO.
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�-f)Qwc�
r � �o
4. ENGINEER'S NAME LAST /FIRST
LICENSE NO.
711 1a 11 114,/`//iZ,(i
('% �l�l
ADDRESS
ENGINEER'S E-MAIL ADDRESS
/�>-o l Ivl i�J�7� �
1A(If /,% / /-h� , 6,VVI
CITY STATE ZIP
Al ,v1j
PHONE NO.
G7z=iay1 c f% ? Z,'o 7
1 I-)/y-,k,3'a -" 1p/o0
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
T ( � / /�� 0 0 LS
A77-) U
`" 3
No. Class
ADDRESS
`J (W
CONTRACTOR'S E-MAIL ADDRESS
jj CITY STATE ZIP /
//���' ✓'7L1/i/� C yz��
PHONE NO.
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OFFICE USE ONLY
PERMIT NO. Fou) - C) D
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $�
Fortes\Pool spa appl (rev3-04).xls