HomeMy WebLinkAboutS2019-0092 - Permit ApplicationS2.0V(i-0D`2-
WORKSHEET FOR POOL COMBINATION PERMIT APkf&rION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
9 "3 �'C RT S � vl
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK 1V w
SWIMMING PO SPA
Check Appropriate box for Applicant
uj Areca ,Q✓c�,'\A3
V5 `-- ESTIMATED $ VALUATION
POOL FENCING I]'`—
(�
DRAINAGE �]
3. OWNER'S NAME LAST FIRST
ADDRESS
tc�(A-5 Pct/7 S
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
y�
N IJ IJ
4. ENGINEER'S NAME LAST FIRSTLICENSE
v CIV`s �rcL,
NO.
ADDRESS A /nom �
NC A5 -7//I
ENGINEER'S E-MAIL ADDRESS
r2� C�-C—,
CITY STATEZIP
G,f�'(5 �-- CA- q z 2-C, �
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
5 P�jol yG� CS
�No.1039(M Clas�
ADDRESS
E-MAIL ADDRESS
YCONTRACTOR'S
Z ZCho l`--
CITY STATEZIP
PHONE NO.
-r -5�CA-vv) �az b-- q --
'E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls