HomeMy WebLinkAboutS2019-0062 - Permit Applicationof "m WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION 0161 •ZOI q
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„ CITY OF NEWPORT BEACH S�019 006a
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
1 'S L -a -N E --
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK PobL- �(�Qr .96,g
ESTIMATED $ VALUATION
SWIMMING POOL SPA POOL FENCING ❑ DRAINAGE ❑
Check Aoorwriate box for Aoolicant
3. OWNER'S NAME
LAST
FIRST
�WJNINL- RoJ4C--�
ADDRESS
OWNER'S E-MAIL ADDRESS
2v IS( SMA- 5T-
S-(;- ISO
CITY
STATE
ZIP
PHONE NO.
W7 -c &RT
92&Gp
Z5 .x}200
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
�—AL
6'76S6
ADDRESS
ENGINEER'S E-MAIL ADDRESS
rJ1�1 TuSTIr� AJC
f+�DD L Poul E)J G . ClaM
CITY
STATE
ZIP
HONE NO.
AT`11tiik iJ`�
Cl,
9?-- 68
P)4-,&30-&(00
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
((
J t,,7 3 2-S Classs.
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
3,--365
\M @ ScN:jj.kaz-Po6Ls .cam. vl
CITY
STATE
ZIP
PHONE NO.
6D-3TA
9E62(4)
-71A ..�2-4
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls G m 5 ® 0na� i �,Z,���