HomeMy WebLinkAboutS2020-0176 - Permit Application (2)WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
F LLl4,. In
U CITY OF NEWPORT BEACH
BUILDING DIVISION
�01 T19
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
19 Z-5 HI G1.1 1_
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK z° W ` 001 Z6 X `1 G O S
C A, -c ° ESTIMATED $ VALUATION LA 7 t b" o
SWIMMING POOL SPA POOL FENCING ❑ DRAINAGE
Check Aooronriate box for Annliran+
3. OWNER'S NAME LAST FIRST
Itl O tM jZc;,+-
ADDRESS
OWNER'S E-MAIL ADDRESS
�9Z?j HI InI --kc, -rNv 17 -
CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
\
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
Vl,A C � Z�s 0—+
�T(:)
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
o 5+z, .I '} S C ?p u t G P c >
ST3 6t 53 -Wl
7
No. `6OR6�� CIasS-3
ADDRESS
�4—
CONTRACTOR'S E-MAIL ADDRESS
-537 (7u/'z✓ Q✓
CITY STATE ZIP
PHONE NO.
N T' c GI z (� lfl 3
CE USE ONLY
PERMIT NO.
no �
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls