HomeMy WebLinkAboutS2019-0078 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLCAJC PKIN 1 UK I YPt
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
7;y�
LEGAL DESCRIPTION
LOT
BLOCK
TRACT
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATION
SWIMMING POOL 95SPA ® POOL FENCING [r DRAINAGE [8
Check Avorooriate box for Auolicant
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
rfG Lc C—
ADDRESS A� j �/J 1
�6 � & c .1" 1 ,9L_� 4 L LJ
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
C z 4b -
PHONE NO.
71-105zr-)
5. CONTRACTOR'S NA
BUSINESS LICENSE
STATE LICENSE
No. Class
ADDRESS
3cl GI l LLc 2C r3C vss-621tm
CONTRACTOR'S E-MAIL ADDRESS
Z
CITY STATE ZIP
`� LU �vc� C'
PHONE NO.
:E USE ONLY
PERMIT NO,
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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