HomeMy WebLinkAboutS2019-0026 - Permit Application`µP " WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
J� CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
2 a/
LEGAL DESCRIPTION
LOT 2 BLOCK TRACT l*a3n g
2. DESCRIPTION OF WORK
f1iL_�A;' NSWn/Un/� ESTIMATED $ VALUATION �S$�
SWIMMING POOL SPA ® POOL FENCING DRAINAGE
Check ADDrODriate box for Annlirar,+
3. OWNER'S NAME LAST
FIRST
f'
Gres PNrA
ADDRESS
OWNER'S E-MAIL ADDRESS
mn n N
1,9n, aid r' ry�vi
CITY STATE
PHONE N
Gl/�x'T
a
k
4. ENGINEER'S NAME LAST
FIRST LICENSE NO.
Pori L
ADDESS
tEW EER'S E-MAIL ADDRESS
✓c/� ay.�otw( a,r
CITY STATE
ZIP PHONllE NO.
5. CONTRACT R'S
BUSINESS LICENSE STATE LICENSE
/NAME
Cu { S CUSS (C f70
% 2'�)C9 2 0( Cp No. 72' / . Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE STATE
ZIP
PHONE NO.
7iy-x
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
SZai9-oo26
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