HomeMy WebLinkAboutS2020-0141 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS) —
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK � �J t 7 /��
an rr/ ESTIMATED $ VALUATIO {/ Y
SWIMMING POOL SPA ❑ POOL FENCING 9 DRAINAGE %
Check Appropriate box for Applicant
3. OWNER'S NAME / LAST J RjS,jT
ADDRESS
tv—
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
N�wPUI bb c�
PHON€NO.
114. 95. 700
4. ENGINEER'S NAME LAST FIRST
CAP. I � wiAto
loqwwg
LICENSE NO.
ADDRESS
GINEER'S E-MAIL ADDRESS
� �T
CITY STATE ZIP
o'b" 77 /,/ I G t z-11114"IF"lQw,
PHONE NO.
5. CIIONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
, - )LI/l. C � �l `P�
" �(4'S /ol
No. Class
ADDRESS
SS II �1
�)o W�iIYL�C
CONTRACTOR'S E-MAIL ADDRESS
(hs,II,nc"4S ; ✓null ccw
CITY _ n STATE ZIP
��, �� � o 4 ]�& q%
PHONE NO.
q 3S-
'E USE ONLY
PERMIT NO. '52- ( Ol Ll I — �Z-L
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Formsftol spa appl (rev3-04).xls