HomeMy WebLinkAboutS2019-0152 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPVON
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Rot Ic Z7—�- 2 eV0 !�2& �^ 7D�
ESTIMATED $ VALUATION
SWIMMING POOL] SPA 2( POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Aoolicant
3. OWNER'S NAME LAST FIRST
ADDRESS v
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
G)rbo D. 06-
PHONE NO.
0. air-
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
l 201 Al • 7t.2'io &P
CITY STATE ZIP
� ;n � 9280?
PHONE NO.
y/Y 6l
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE C63
Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
/bE qA Sf
CITY STATE ZIP
PHONE NO.
Z 70
17114- 3-
:E USE ONLY
PERMIT N0. c
PLAN CHECK NO. v l
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls