HomeMy WebLinkAboutS2019-0193 - Permit Application�Fw r WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
Ert „rs CITY OF NEWPORT BEACH
PLEASE PRINT OR TYPE BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK 1'u C ))"L , . 1
ESTIMATED $ VALUATION ��'c2co
SWIMMING POOL SPA V POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Aoolicant
M'3. OWNER'S NAME LAST FIRST
6 ®I c; ck Rcir co"w� k6 -w t d A -v -h
ADDRESS
66 I (, � A3 Ifs -r,
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO,
N Lis U0 )-5PAc;h C- 91ibb3
4. LAST FIRST
1C0i�C'Z
LICENSE NO.
ADDRESS I
ENGINEER'S E-MAIL ADDRESS
1092-5 b6vyA YL; ,--- A n. t (q
CITY STATE ZIP
IPHONE NO.
F-JI'0 `r \1�1 )e V -/��
❑ 5. CONTRACTOR'S VAME
c�
BUSINESS LICENSE
STATE LICENSE
C 5
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No.���30V Cla s
ADDRESS
CONTRACTOR'S E, -MAIL ADDRESS
2 e b vY . 41F)'12-
�UI ®"�9 Erf p��! e
CITY STATE ZIP
NO.
JPNONE
C me5a C
IN 7. 9�5 3�3�
CE USE ONLY
PERMIT NO. SCS/ l� - kCt
PLAN CHECK NO. LZb-2 -- Z-01 457
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls