HomeMy WebLinkAboutS2020-0190 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
I t�`
CITY OF NEWPORT BEACH
BUILDING DIVISION
rLcgOC rKIN I UK I Trt
I. PROJECT ADDRESS (NOT MAILING ADDRESS)
2 So • IJWYA STREET C-4. 7Z44-D
LOT
BLOCK
2. DESCRIPTION OF WORK / R. w To A
SWIMMING POOL ❑ SPA M/
Check Appropriate box for Anniir_ant
TRACT
ESTIMATED $ VALUATION 30, oo tj
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
7-AAWE XW 1AAl
ADDRESS
OWNER'S E-MAIL ADDRESS
4 So BvNyq TT.--ev-r
CITY STATE ZIP
PHONE NO.
/
/✓ew v�'T 9-ewit CA . 21.9 Ca4U
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
/,?O/ N. ?t.IJ 7-i AJI
CITY STATE ZIP
PHONE N
A.✓sailP.rn c'A _ �j Z�li7
i-7iy�6sc--/oa
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
n
�c%lWA/c z /D O Lf
Noclt,=y lasses
ADDRESS
'�5�3
CONTRACTOR'S
CONLTRACTOR'S E-MAIL ADDRESS
, 1p. /t 0� .2
7Ga1�JJJt ii h/tl/��a0�f re.-"
CITY STATE ZIP
PHONE ND.
J A v7-4 I AI A �-,q `iZ 7 9 9
q g 9,J r7 Z- D 5- t)
:E USE ONLY 7
PERMIT NO.
LAN CHECK NO. I as
OOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
OLO-LU— 000�
3'1 6? 1