HomeMy WebLinkAboutS2019-0033 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
/'� CITY OF NEWPORT BEACH
�� BUILDING DIVISION
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as
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(NOT MAILING ADDRESS)
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2. DESCRIPTION OF WORK 00\ Q'eYl wkr, I iy\tW S\& 6AA.Hoy1
POLI ' to 33 5m.-%' 52SL (M �V ESTIMATED $ VALUATION -T SDj ODD
SWIMMING POOL 24- SPA ®- POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME
LAST
FIRST
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N
OWNER'SE-MAIL ADDRESS
�1ADDRESS
O 5cey)iL N�T
CITY
STATE
ZIP
PHONE NO.
fu OYA- &ekst
C
612. U5
[310°113-5110
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
Inv
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4-1 v5w
ADDRESS
ENGINEER'S E-MAIL ADDRESS
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abt N .-SiiV)
CITY
STATE
ZIP
PHONE NO.
-AymW fy\
G{9
61210'1
1 Cl"�) (A'.6-1, oo
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
movioMor - 'PooINC,
No. 101 333 Class (5
ADDRESS
.
CONTRACTOR'S E-MAIL ADDRESS
V'C ' GW
lYgvi� D c fi s.tovn
CITY
t
STATE
ZIP
PHON NO.
Fove 5t
61l 6160
543 I2\C;
USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls