HomeMy WebLinkAboutS2019-0018 - Permit ApplicationSZoLq- oo.i�
0WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
1. PKOJEC I AUUHE55 (NOT MAILING ADDRESS)
AAX�V- 0,&AM, , CSA 9�C�Gl D
LEGAL DESCRIPTION
LOT BLOCK �^C TRACT
2. DESCRIPTION OF WORK % Y�/ o�J / ��GL%%Q��� 9[AE(17JFX� %L
ESTIMATED $ VALUATION 00
SWIMMING POOL ® SPA ® POOL FENCING ❑ DRAINAGE ❑
Check Aoorooriate box for Aoolicant
3. OWNER'S NAM \ LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
212
CITY STATE ZIP
PHONE NO.
z126a19
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4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
05. CONTRACTOR'S NAME E� /LQ/�I��`�/�/E �/
BUSINESSLICENSE
STA,T/EJ LICENSE
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No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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F� y/9,�ao, e,91n
CITY STATE ZIP
PHONE NO.
0 619 X01
766- 67i?- oij5'
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
(3w.07100 144o - �
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