HomeMy WebLinkAboutS2019-0143 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
'7\�'CA
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Q� y� C1C \CC_C [ CV� 6 C rACQ
aka\� ✓I / J 7--C)Q -<,`�- ESTIMATED$ VALUATION
(0
/CX
SWIMMING POOL ❑ SPA ❑ POOL FENCING ❑
Check AoDrooriate box for Annlicant
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
\\-b\ \'c�C% x�\
CITY STATE ZIP
PHONE NO.
CN azGC-D
-jZ-7
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
� oN �3 � �
c)�),co 0 �cj��e� ng
CITY STATE ZIP
PHONE NO.
l C ttIN
71W ,6"•A `rol00
1
® 5. CONTRACTOR'S NAME
BUSINESS L`IICE�{NyS'E�
STATE LICENSE
/'
V
Noq 6-766 Cla s
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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i�r���Y ��u��1o��•Co.�-��
CITY STATE ZIP--[P—HONE
NO.
}JCC.' ,k C, /-� cac,60 1
GSC{
:E USE ONLY
PERMIT NO.�13
PLAN CHECK NO. 9 5
POOL P/C FEE $
DRAINAGE P/C FEE $ \�