HomeMy WebLinkAboutS2019-0166 - Permit Applicationgn 1 q - 01'Lpy
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
5(26 Aew ar•f 06,� ��e!iG
LEGAL DESCRIPTION 0,� (02�-O61_ 2y �c�ri5�; C�O•p7
LOT C BLOCK TRACT
2. D SCfP/TION OF WORK
CiIQ ,/Gg�cYj �✓prlC�l:tf. l •� i-���ac�rck/Z ESTIMATED 2-5 b
$ VALUATION
lJA r :GZ
SWIMMING POOL ❑ SPA � POOL FENCING ❑ DRAINAGE ❑
Check Anaronriate hox for Annlicant
3. OWNER'S NAME
LAST
FIRST
A/14,-01
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY
f UPW
STATE
ZIP
PHONE NO.
a--t
C x
a 0
qy,- 720 - 2eZI
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS
BUSINESS LICENSE
STATE LICENSE
l�(�+ ✓
� p �
5-m— � t,o
!�5(0(( C
No. Class
ADDRESS
CONTRACTOR'SE-MAIL ADDRESS
�.���
YY1�5c) V)C?tG'��>)
CITY
STATE
PHONE NO. i150,
^ZIP
CE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
4
Forms\Pool spa appl (rev3-04).xls