HomeMy WebLinkAboutS2020-0061 - Permit Application (2)WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
i CITY OF NEWPORT BEACH
BUILDING DIVISION
rMIN 1 UR 1 T rG
LOT
(NOT MAILING ADDRESS)
2. DESCRIPTION OF WORK 14[-j l ?mc(- Ljbgf
cam, /y/'
YN+t^� �-{ E� WqD POOL, 3E)5 ESTIMATED $VALUATION
SWIMMING POOL SPA El"� PQQ6 FENGNQ—Q` DRAINAGE
Check Appropriate box for Aoolicant
3. OWNER'S NAME ( r \p LAST FIRST
? S E;
ADDRESS
OWNER'S E-MAIL ADDRESS
STATE ZIP
AA- C� C4 C1%b25
Co -"AA-
i
PHONE NO.
{
.`9`(� .1,l7/) -
4. ENGINEER'S NAME (y -n LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
an
C4 07 2.-8-0rw
PHONE NO.
vX,
5. CO(N�RAAtCCTOR'S NAME
BUSINESS LICENSE
STATE LICENSE (/1�
��L
No'7 Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
:fid C
PHONE NO.
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Norms\Pool spa appl (rev3-04).xls
f-
n til 16* %O we
&%*U • C 2,
6 V_