HomeMy WebLinkAboutS2020-0119 - Permit Application (2)_I
y" °k WORKSHEET FOR POOL COMBINATION PERMIT APPLIC
CITY OF NEWPORT BEACH /
BUILDING DIVISION (�
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
/9757- P'OR7 9XIr-ro[. f1RrcE A✓Es✓PD/ZT 6P4c-.4
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Ne -w Ah
SWIMMING POOL ®/ SPA Lys
Check Appropriate box for Applicant
_ ESTIMATED $ Vi
POOL FENCING ❑
DRAINAGE ❑
❑ 3. OWNER'S NAME LAST FIRST
r4/TJ-/d/(E,l F/NE AD ME,S
ADDRESS
OWNER'S E-MAIL ADDRESS
p
/975' �O9r 9X -IX rA4 C/. C-eE
,/P.Zen1 il7GriJJ!►✓6P.l�A/P/iuw1�
CITY STATE ZIP
PHONE NO.
A1d yV,4o.4?7' oge40-/ rA, 9'z b 6 D
C?V?)7ZZ» S75'55*
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
Al 4TT/1 E r✓ �a.� p.r m 1✓
r% D 3-%
ADDRESS
ENGINEER'S E-MAIL ADDRESS
/Zo / /d, 7}-JT/n% -er°P
iYlli4TT�/E`✓�(D �ODC c-4). na."
CITY STATE ZIP
PHONE O.
,/1AIA,►E.,Al) c`A �2�li7
('7/y�63D -4>ot
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
J'C- A/ W A qZ VO9>G.J'
o Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
-;*PA4 s -rood"
i dr'c-l-)WAX ZPvot.r, CPA -1
CITY STATE ZIP
,7-4 N T.d 14 <-14 .92 7 % % P ,t
P ONE NO.
, �,rr•y
z . • 76bS
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls ID
2-0 1 cl _ os�f 2—
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