HomeMy WebLinkAboutS2020-0038 - Permit Application (2)04: a WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH S 207 — 007 )
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS {N OTMAILINGADDREss)
/
2�.3Z_ ?I
LEGAL DESCRIPTION
LOT BLOCK TRACT
FDESCRIPTIO'N OF WORK
ESTIMATED $ VALUATION
L [ -8FA
0 3. OWNER'S`NA LAsr F
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Z-1
IRST
ADDRESS
?� , P44 f%
OWNER'S E-MAILADDRESS
CITY I �`-�'
' � ZIP PHONE N�Oj;
'3
��STATE
FIRST 60 �� •1
4. ENGINEER'S NA E r LAST
�t�� 1A LICENS NO.
ADDRESS
f
ENGINEER'SE-MAILADDRESS
CITY STATEG�LN"
�IP PHONE N
a
NTRACTOR'S NA
BUSINESS LICENSE SATE LICENSE
ADDR S
ez 3 �T
No. OJ 1 / Class
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE
PHONE NO
�ZIP
/
2FFICE USE ONLY
PERMIT NO,
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
FormslPool spa appl (rev3-04).xls
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