HomeMy WebLinkAboutS2020-0119 - Permit Application (3)0°` WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
,r ,;> CITY OF NEWPORT BEACH
PLEASE PRINT OR TYPE RR
CY' BUILDING DIVISION SIMN ...16
1. PROJECT ADDRESS (NOT MAILING ADDRESS) -
975" PO.?T 9/f I— ,�'lRrct IvevRolz i Neo
----------
LEGAL DESCRIPTION --
LOT BLOCK TRACT
2. DESCRIPTION OF WORK N 1V e0G0 L
— s ESTIMATED $ VALUATION .Slip 10,04SWIMMING POOL R' SPA Lys POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST
FIRST
Rirr/NGE.� /-#-, A MES
ADDRESS
OWNER'S E-MAIL ADDRESS
/975- A09 -r 46Af -If rDL Col .4czE
I,/vRv-my(z)la/iJJONCP.I NPeVvMe
CITY STATE
ZIP
PHONE NO.
Ale)VO00Rr «, (�A.
G/zr.G®
r9y91�zz»s7rs
4. ENGINEER'S NAME LAST
FIRST
LICENSE N0.
M4-rnve / �"�an�pJa/✓
r6b5-/
ADDRESS
ENGINEER'S E-MAIL ADDRESS
/10 / A/. 7LJT/ei% -dY�-
ei/ArrWEh17(1> loot e4 roxj
CITY STATE
ZIP
PHONE O.
eQovANE✓ /�'!� c -A .
q 6.3,0 - e, A06
E] 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
n
XCHWA. -Z PO®G
No. Class"
ADDRESS
P?®. -go y
CONTRACTOR'S E-MAIL ADDRESS
C, p r /)&V l.9-zf0oov®err
eAl 2 Sc'/-)WAAZPooss, r4pA7
CITY STATE ZIP P ONE NO.
;E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
roans um spa apps (reva-u4).xis y ` zz I C, n
• VOB