HomeMy WebLinkAboutS2019-0148 - Permit Application?�Wa'* m WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH 5ZM-0/16$
`E � BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT A DRESS (NOT MAILING ADDRESS)
17
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK q-C-"Pf--
SWIMMING POOL SPA El
Check Appropriate box for Amlicant
ESTIMATED $ VALUATIONS
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
�� a .
1 (ice vlgra
CITY STATE ZIP
4 w 9 60
PHONE NY
IY'7 510 8��r
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
G'ID 4he,-1
ADDRESS
ENGINEER'S E-MAIL ADDRESS
17 -el M. '7vs17A1
CITY STATE ZIP
PHONE NO.
&1z -v7
.7141 6*e
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
No. 02,�;,S Class ni C
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
Z2�n 5 Lf9 r 9.�i AfV
CITY STATE ZIP
PHONE NO.
a✓�i�,� Z-IlvbA
(OFFICE USE ONLY
PERMIT NO.
i
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls - K' 015�-