HomeMy WebLinkAboutS2020-0136 - Permit Application1 111 �
'IA W HEET FOR POOL COMBINATION PERMIT APPLICATION
F 4 � ,
��' n BUILDING DIVISION CITY OF NEWPORT BEACH
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PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (N AILING ADDRESS)
FFo rr �i F7
LOT
BLOCK
TRACT
2. DESCRIPTION OF WORK_N iV4 [N6 fOlAOtO %6L_ �?j' X ( 'ry,,,a 5r
`ia, 5 ESTIMATED $ VALUATION Lls7a)O
SWIMMING POOL SPA LV]/ POOL FENCING ❑ DRAINAGE m�
Check ADDrODriate box for Annlicant
3. OWNER'S NAME
LAST
FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
P
C�—
q ez 0
4. ENGINEER'S NAME
/z, c
LAST
2�dL2v, hCCIq
FIRST
C'J/I5
LICENSE N0.
ADDjRESS
f `'"?
i yT 1A /
ENGINEER'S E-MAIL ADDRESS
CCTY
ILIIVn` t WL
TATE
ZIP
PHONE NO.
63D-(00
5. CONTRACTOR'S NAME Tf1
57
BUSINESS LICENSE STATE LICENSE
WI SC�i C,5
1.7r,36&& 3q
No. CC96 Class
ADDRESS
�3-5 (� e
✓
CONTRACTOR'S E-MAIL ADDRESS
✓
CITY
STATE
ZIP
PHONE NO.
p
9266-3
cm��a6�t�
'CE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Fo"s\Pool spa appl (rev3-04).xls