HomeMy WebLinkAboutS2019-0030 - Permit Application"r WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH su IU -WN
BUILDING DIVISION
PLEASE PRINT OR TYPE o\4 u
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK
2. DESCRIPTION
,OFWORK 1�O�1Cy Pie �W' ��'Y j ecyj Sprl fN(ono)"'-4\"C
ESTTIMATEDT�$ VALUATION
'QIC. 9- 52-( G 3 4
SWIMMING POOL ❑ SPA ❑ POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
(j,-" U� ES ri()Y�&' t
CITY STATE ZIP
4 P� J, Ci�l
PHONE NO.
3) o -7
�, o 2-9'11
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
Wl
ADDRESS
ENGINEER'S E-MAIL ADDRESS
2 6,c S ?fU
CITY STATE ZIP
PHONE NO.
LCA 12ore--_-,(Z-a ?-v, 30
`/ql" 0(o
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
W a v AD A --A, 5c)n
V�a�<,>K C-5-3No.
Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
4i 9 G U ,6v,7°d k
CITY STATE ZIP
W �4� '1 yl,:Pr C- qz� ��
PHONE NO.
I /Lf 3,)� 6��1
CE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls