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HomeMy WebLinkAboutS2019-0147 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION ' CITY OF NEWPORT BEACH BUILDING DIVISION PLCASC I•KIN I UK TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) LEGAL DESCRIPTION LOT BLOCK 2. DESCRIPTION OF WORK Re/;/cS few 0 ©a` c -,d 3f-, SWIMMING POOL W Check Appropriate box for Applicant _ ESTIMATED $VALU�� POOL FENCING ❑ DRAINAGE ❑ 3. OWNER'S NAME LAST FIRST 1-(-e(r 444 Z- ; k-) ADDRESS /� p �/ �y ( d�� 200.! �O' 9 )1t.- O�WNER'SE-MAIL ADDRESS /`f ( V / Cc, CITY STATE l[/�w PC r �4c S ZIP i Z�� PHONE NO. � l - � �� - y.� s 4. ENGINEER'S NAME LAST FIRST LICENSE NO. ADDRESS ENGINEER'S E-MAIL ADDRESS 7 CITY STATE ZIP PHONE NO. 5. CONTRACTOR'S NAME BUSINESS LICENSE STATE LICENSE II ZA-- CM C BIZ r'c�)o`S z'� s 7�/ 96' No. Class ADDRESS CONTRACTOR'S E-MAIL ADDRESS CITY ZIP PHONE NO. QSTTATE OFFICE USE ONLY PERMIT NO. PLAN CHECK NO. I I IBJ' POOL P/C FEE $ DRAINAGE P/C FEE $ Forms\Pool spa appl (rev3-04).x1s