HomeMy WebLinkAboutS2019-0023 - Permit Application (2),�'"" °°'r WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH Q
"�� BUILDING DIVISION S��-`'� �
r=As r rnuv i UM i t rC
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK `[ cl tl�
ESTIMATED $ VALUATION 17, 0 0
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SPA P t �Z��m.+aT n �
f'_hmrlr Annrnnrinfm hnv fnr Annlinnnt
3. OWNE'S AME LAST FIRST
Ic2.1 0.-5e- CL, _ _ A/1A-iR-,
AjDDRESS
OWNER'S E-MAIL ADDRESS
l o ce S /1
CITY STATE ZIP
PHONE NO.
�e-c7I,JA-- m+(�
lV5 ffV11'72-)
4. ENGINE R'SNAM,, ELAST FIRST
LICENSE
//NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
(20l (\A .-TSj/�j
CITY STATE ZIP
A° / " (--t-- �,� 7
PHONE NO.
71voc)(,)10 0
❑ 5. CONTRACTOR'S NAME
'30r
BUSINESS LICENSE
STATE LICENSE
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-- mou I I rl-. Locs
N D (�!i'
Class
ADDRESS
3 9 p7 5 1'%eje,
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
3 7� l
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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Farms\Pool spa appl (rev3-04).xls -- o I ` ` 054