HomeMy WebLinkAboutS2019-0056 - Permit ApplicationPLEASE PRINT OR TYPE
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DGSI-,2019
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH S- IA -fes
BUILDING DIVISION
. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK ` K l 0r) L S PA PLAS'-t7:7�2,
ESTIMATED$ VALUATION
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SWIMMING POOL SPA POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
03. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER' E-MAIL ADDRESS
11703 6�-, P
T by e TU a rrl113 CoN
CITY STATE ZIP
AiC-W(ZT PCi4 � 92-�-7q7 /
PHONE NO.
qy�- ( 73.32S
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
STATE LICENSE
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No3�0"S-Y Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
20 tt1A-[..lJc1r -4t /�
i >AvG G f[ (ilD�%nl<Ih/ICSr�'Z)�
CITY STATE ZIP
PHONE NO.
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7iZC7-Ltfy3
USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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