HomeMy WebLinkAboutS2020-0053 - Permit Applicationvucmam rKIKI UK ITrt
0-1`1U� 2020 /S',?02,0-00,53
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS) q
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK j7Q
ESTIMATED $ VALUATION
SWIMMING POOL SPA ❑ POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
—a-3—.OWNER'S NAME LAST FIRST
11
ADDRESS
OWNER'S E-MAIL ADDRESS
b►�cu�y�
6
CLL) Ck<Qy�
,.
CITY STATE ZIP
�P CA
PHONE NO.
-76
60
1 q9 - 76 to 'SU
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE -7F-7
ONE NO.
Q 5. CONTRACTOR'S NAME
�Ll
BUSINESS LICENSE
STATE LICENSE
'663
S
-bS,
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
A91 W C A( 04be-\ Avg
Rict/l. riew- h 48- Avmsy4l els, t
CITY/ STATE ZIP PHONE NO.
or P L �l �;
CE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls