HomeMy WebLinkAboutS2019-0158 - Permit Applicationrr ' HC WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
' CITY OF NEWPORT BEACH
c"''> BUILDING DIVISION
PLEASE PRINT OR TYPE
!.PROJECT ADDRESS (NOT MAILING ADDRESS) - -- - --
/11 ct I.tl Li)v L',/IV V A
BLOCK TRACT
2. DESCRIPTION OF WORK NOW SS A
ESTIMATED $ VALUATION2- S
SWIMMING POOL ❑ SPA POOL FENCING ❑ DRAINAGE ❑
CheCK ApproprlaTe oox w. „NYS
LAST
FIRST
3. OWNER'S NAME
I c(E
OWNER'S E-MAIL ADDRESS
ADDRESS
f I
CGOh z L S
.S
CITY
STATE
ZIP PHONE NO.
cc-
92ti5s2 Gil S271,
ew
�
n 4. ENGI EER'S NAME
LAST
FIRST LICENSE NO.
ENGINEER'S E-MAIL ADDRESS
ADDRESS
CITY
STATE
ZIP PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE=STATEEG1Class
CONTRACTOR'S E-MAIL ADDRESS
ADDRESS
Cf ytof
( eGIM6.
Z' Z u
CITY
STATE
�a oil ZIP PHONE NO.
C
f �2 212
tkl ck �r�e
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C.FEE $
Forms\Pool spa appl (rev3-04).xls