HomeMy WebLinkAboutS2020-0038 - Permit Application04' WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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+;. CITY OF NEWPORT BEACH 520% _ dlj c
Z5
PLEASE PRINT OR TYPE BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS
2033Z R1 e
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
6 ESTIMATED $ VALUATION `L
SWIMMING POOL
B DRAINAGE
Check Appropriate box for Applicant
3. OWNER'S NA,_W LAST FIRST
ADDRESS
���� ^�� �� .OWNER'S E=MAILADDRESS
CITY (, STATE ZIP PHONE NO.
4. ENGINEER'S3
JNA E G LAST FIRsr
LA LIC NS NO.
ADDRESS (�
'ENGINEER'S E-MAIL ADDRESS
CITY �IP PHONE NO,
NTRACTOR'S NA BUSINESS LICENSE S ATE LICENSE
ADDR SS No. Class
CONTRACTOR'S: E-MAILADDRESS
CITY STATE ZIP PHONE NO.
OFFICE USE ONLY
PERMIT NO,SC
SZV
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $ �LI
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Formslpaol spa appl (reV3