HomeMy WebLinkAboutS2020-0059 - Permit Applicationo
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION SZjV
PLEASE PRINT OR TYPE
1. PROJECT
ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
Fo)v,1 rugs-Aj
P641-1 (-vj ps f erm )4S . (0;:
��9/683 •y8��
2. DESCRIPTION OF WORK TOO
/
loS 07 ESTIMATED $ VALUATION %0
SWIMMING POOL SB -A-E[- POOL.EENUNG $ _ARAiNAGE E]=
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
A/,6;Q tj— (I �o 6 o
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
L4
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
c�
PHONE NO.
5. CONTRACTOR'S NAME
S%�c£Lfi
BUSINESS LICENSE
STATE LICENSE
Na723g1s- akasl-3
A DRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY�Q� { STATE �^ ZIP
PHONE NO.
74 qL�
USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Fo"s%Pool spa appl (rev3-04).xls
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