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HomeMy WebLinkAboutS2019-0046 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION CITY OF NEWPORT BEACH "41MIMMT BUILDING DIVISION PLEASE PRINT OR TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) Zo G-AAI,9NCT LEGAL DESCRIPTION LOT BLOCK TRACT 2. DESCRIPTION OF WORK rQOZ f4a!a UV AI&I QoHa,/NS7/Y4LWA16W PA&Ily a 44'45-7-/4' S%EPS,565`75' /IND k^ -c U1yf-/NpDOa ESTIMATED $ VALUATION S 3 3 • GO SWIMMING POOL SPA)Nf POOL FENCING ❑ DRAINAGE ❑ Check ADDroariate box for ADDlicant 3. OWNER'S NAME LAST ^FIRST pe-INI f},VNE ADDRESS OWNER'S E-MAIL ADDRESS 70 1-,+1V D fo/zT lgfloecAe, I rin i © m ac l CITY STATE ZIP PHONrz NO. NEuiPoXT G/� `I7460 9 2,?o -66s5� 4. ENGINEER'S NAME LAST FIRST LICENSE NO. ADDRESS ENGINEER'S E-MAIL ADDRESS CITY STATE ZIP PHONE NO. 5. CONTRACTOR'S NAME BUSINESS IN SS LICENSE STATE LICENSE c53 L� �1iv swt irk ooh M� il�/ LE/VGlO p �ZZ No.s?!lR(O Class'951l ADDRESS CONTRACTOR'S E-MAIL ADDRESS Za? W c?V-(--ETe N( A%,(Iff:- CITY STATE ZIPPHONE NO. O,�NFiF I. GFS 9 67 (71e�) 'Vtt7-osR7 :E USE ONLY ,p PERMIT NO.QQJ,, sq O�Q.Qb�y PLAN CHECK NO. D�� •IN, POOL P/C FEE $ DRAINAGE P/C FEE $ Forms\Pool spa appl (rev3-04).xls