HomeMy WebLinkAboutS2020-0124 - Permit ApplicationaNrv, n8`�°c.
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
0—BUILDING DIVISION cW 1���ry
PLEASE PRINT OR TYPE v(21H
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
IqZ`f P)e� I CA
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL Ig
6310 6 4A Y ESTIMATED $ VALUATION 3SoOO -'-)U
SPA )5 POOL FENCING ❑ DRAINAGE �Z
Check Appropriate box for Applicant
3. OW R'S AME LASTb � v FIRST N -1. '
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ADDRESS
191K 'j'I ��
OWNERS E-MAIL ADDRESS
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CITY STATE ZIP
Nor ' CA- q
PHONE NO.
3Gu-7Sv-qT2-7
0 4. ENGINEER'S NAME LAST FIRST
-110VA p0+44mw
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
Atu6v, Ck c4c)7
PHONE NO.
7H G
5, CONTRACTOR'S NAMEy� A4S)h� �-
t`fi.II Y�1101, PCOIE 6$�
BUSINESS LICENSE
STATE LICENSE
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471SU-'�
140. Class
ADDRESS —
731 C 13 11 fed
CONTRACTOR'S E-MAIL ADDRESS
O' Eecngwv Leat �itia 1
CITY STATE ZIP
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PH NE NO.
7/f-7Z`f -8b'y7 11
7E USE OAMY TWO O �1i� � � 6114
!ERMIT NO. V
CHECK NO.
P/C FEE $
3E P/C FEE $
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