HomeMy WebLinkAboutS2019-0041 - Permit ApplicationDDgI
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WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
2. 21,3
LEGAL DESCRIPTIO
LOT
BLOCK TRACT
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2. DESCRIPTION OF WORK
7� �— / ESTIMATED $VALUATION ZS---
SWIMMING POOL ❑
SPA 2 POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant FIRST
FADDRESS
NER'S NAME LAST /
I ' /I V I it
WNER'S E-MAIL ADDRESS
'JolP Y / Ile
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LAST FIRST LICENSE NOS,
4. ENGINEER'S NAME n 7L>
ENGINEER'S E-MAIL ADDRESS
ADDRESS
A VA
�STATE ZIP PHONE NO.
CITY !/%�
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BUSINESS LICENSE STATE LICENSE
5ON�TgRACTOR'S NAME f 7 /
2pG 11 Class
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L! � P CONTRACTOR'S E-MAIL ADDRESS
ADDRESS
j 2-OZe
STATE ZIP PHONE NO.
CITY
OFFICE USE ONLY ` 1
PERMIT NO.
-76
PLAN CHECK NO. W "�
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls