HomeMy WebLinkAboutS2019-0097 - Permit ApplicationS201I I - 00CI1
q�� "° a WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
n �4�- CITY OF NEWPORT BEACH
BUILDING DIVISION
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1. PROJECT ADDRESS (NOT MAILING ADDRESS)
Z 3 3 'I A Q a 4
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL Ca/
LSO L' - 511>/I
SPA
Check Appropriate box for Applicant
�'_�/'�/'ESTIMATED $ VALUATION
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(I f?0 C>
DRAINAGE D'
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
Z33OL A-RAL-iA
CITY STATE ZIP
PHONE NO.
CA- 9 2
7/ �r //-7 3
❑ 4. ENGINEER'S NAMELAST f FIRST
C
LICENSE NO.
7 3
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
UZl V`-` - -ws 1 I
CITY STATE ZIP
wltIw. cc�- 52,�u 7
PHONE NO.
-71 630 (,M)o
5. CONTRACTOR'S NAME
�'yf��
QvAl✓l
BUSINESS LICENSE
STATE LICENSE
S 5>7
NCILCR4Ja CI
ADDRESS
�qo � P�Gw�c721 G 70-\�
CONTRACTOR'S E-MAIL ADDRESS
CT'TATE ZIP
69-k���� 27
' 0
��NO.
/70k
:E USE ONLY
PERMIT NO,
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
5Z c I - 0b"I 7
kZ91-2011