HomeMy WebLinkAboutS2020-0035 - Permit ApplicationN Pp
ryaaoz ,&" o� WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION n
s CITY OF NEWPORT BEACH
BUILDING DIVISION 520010,,. G('
PLEASE PRINT OR TYPE .7
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LRP
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
I '
4� 4� ESTIMATED $ VALUATION 1,4,!,5700
SWIMMING POOL ❑ SPA ❑ 'SPOOLfENGWG—B DRAINAGE
Check Anorooriate box for Anolicant
tal 3. OWNER'S NAME LAST FIRST
5-WAe-1-L✓C
ADDRESS
OWNER'S E-MAIL ADDRESS
S64-
CITY STATE ZIP
(,le�JPY i "oA-s F 5 2- (a 3--)
PHON NO.
�7/ -5-Jr7517
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
ITYf STATE ZIP
r� z
46ir
PHONE NO.
ll
IiA�
5. CONTFACTOR'S AAME
BUSINESS LICENSE
STATE LICENSE
,,,
Nor � Class "
ADDRESS
701 13
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
rA-
PHONE NO.
X 77
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C
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