HomeMy WebLinkAboutS2019-0011 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
�"92 5--B 13VS_S_6->t_ _
LOT r� BLOCK TRACT I
2. DESCRIPTION OF WORK CC)L a � SPn 6
Pn)c> 5QA I NA 5tII�",?4EPLAS1'EV- ESTIMATED $ VALUATION '7-Ot`00i
SWIMMING POOL ❑ SPA Ly DRAINAGEo
Check ADorODriate box for Aoolir-ant
3. OWNER'S NAMES� LAST FIRST
ADDRESS
1 55 SOSSl✓Y LA
.OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
P ONE NO.
CA-- 9 -0
Q11Q
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
(
ADDRESS
__' ENGINEERS E-MAIL ADDRESS
t
CITY � _ STATE ZIP
AUi�4l �- � ` 1
PHONE NO.
4kp�
QGrdw
5. COCN,TTRRACTOR'S NAME
-BUSINESS LICENSE STATE LICENSE
No Class
ADDRESS - f
CONTRACTOR'S E-MAIL ADDRESS
41
I.40 l I� F;I� � i y � .. -.
CITY 'STATE ZIP
PHONE NO.
--Cu S' �1 rj CA- g b
�� �0% 510
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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