HomeMy WebLinkAboutX2019-0054 - Permit Application1 X% 09 1-00GI4
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
7.10 �o,,�6�OPaC � � Pt?F�
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK XWYYoo�l k 4 Q7Co
SWIMMING POOL [ L SPA ❑
Check Appropriate box for Applicant
ESTIMATED $ VALUATION
POOL FENCING ❑
DRAINAGE ❑
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.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
V i3w os"
STATE LICENSE /1
No.32 2 - Class
ADDRESS AveCONTRACTOR'S
l-s®D 0 A
SE -MAIL ADDRESS
ro'4r e 5444 wijsfdc kc- cow*
CITY STATE ZIP
-�Altf*oxo CA Iqua's
PHONE NO.
I ilii -Sig
;E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
Xa-o� � -posy