HomeMy WebLinkAboutX2020-2825 - Permit Application1
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION /L� _ 2(Y zIS
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS) ,
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL
SPA L(2✓
Check Appropriate box for Applicant
Sv4
_ ESTIMATED $ VALUATION
POOL FENCING ❑
DRAINAGE I
LAST FIRST
3. OWNER'SNAMA�/�,
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ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATEZIP
Wit, SPUR%, `3
PHONE NO.
001'7
4. ENGINE74j;o ME LAST FIRST
L, ��/n/✓I
LICENSE NO.
ep'/l 3
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ADDRES/SA� � f!J `' n j G
I! ),11. YFJ / V,N' 5
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
OPIX
PHONE NO.
zSP'7
i 3�3
OR'SNAME
5. CONTRWim, L
BUSINESS LICENSE
STATE LICENSE
3
No.913 CI sS
ADDRESS 7
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CONTRACTOR'S E-MAIL ADDRESS
CITY STATEZIP
�I�fzt s CA 1
PHONE NO.
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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