HomeMy WebLinkAboutS2020-0192 - Permit Application (2)S2O_V �OIgZ
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
J r4 �G
CITY OF NEWPORT BEACH
PLEAS
"BUILDING DIVISION
E PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
ILEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK 2s9?q
SWIMMING POOL [:1 SPA
Check Appropriate box for Anolicant
_ ESTIMATED $ VALUATION V,"UCS
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
ADDRESS
,�73.5Y
OWNER'S E-MAIL ADDRESS
/CITY �S,TATE ZIP
/,-b��✓/-v✓'—% �(il Z / Alw
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
BUSINESS LICENSE
STATE LICENSE
IN A
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO. 2010W
7 �w
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls