HomeMy WebLinkAboutX2019-0110 - Permit Application0�41",
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH )(,`gDlq-C X10
BUILDING DIVISION
Ver Oo rrtmi um r rrc
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
)-Oa1 E. 3G flde. Ne036 Bea.1 CA
LEGAL DESCRIPTION
LOT 10 'I oR . i BLOCK TRACT
2. DESCRIPTION OF WORK A f -c OV CL, 64— LA4 Sl �uT'cso 1
ESTIMATED $V LUATION
SWIMMING POOL SPA POOL FENCING ❑ DRAINAGE ❑
Check ADDrouriate box for Annlicant
3. OWNER'S NAME LAST FIRS
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME A 0��?�7 " ers�n�NG�
VLI'i— 1 G.
BUSINESS LICENSE
STATE LICENSE
lNo. 6.16AD-7s ClassfS
ADDRESS
cso GL C A- 43 6Z
CONTRACTOFTS „E --MAIL ADDRESS
reu162 ea�i� l bvi FeLF3z 5s cop—/
J
CITY STATE ZIP
PHONE NO.
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $ ()'O
DRAINAGE P/C FEE $ �� (�F
Forms\Pool spa appl (rev3-04).xls