HomeMy WebLinkAboutS2019-0009 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDR SS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIRTION OF
SWIMMING Pool
amu. �U1 p SD e, y8`z- + %Z-
L ESTIMATED $ VPaLUATION
0G0
SPAL�_ POOL FENCING ❑ DRAINAG
Check Aoorooriate box for Aoolicant
3. OWN S NAMES LAST
FIRST
/�
( r I
ADDRESS
OWNER'SE-MAIL ADDRESS
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-S�'(_e
CITY STATE
ZIP
PHONE NO.
4. � FIRST
INEER'S NAME �} LAS �C
LICENSE NO.
Pc/ Ci( � 11 zf�T l /12
ADDRESS
ENGINEER'S E-MAIL ADDRESS
d -U I
CITY STATE
ZIP
PHONE NO.
u
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01-yX\
TOR'
5. C77,
LICENSE
STA//TE LICENSE
NAME {�p/BUSINES7S
( i 1. l.ir" ' `_C �/'c�G
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No. 6 C S - Class
ADDRESS 1
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pS�,�/
CONTRACTOR'S E-MAIL
ADDRESS
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Lsec
ZIP
ZZ -26> &/
PHONE NO.
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
� 32.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls