HomeMy WebLinkAboutS2019-0002 - Permit Application4�D?,o iq -000�-
4 `w°°'r WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
ueTti,.�=., f CITY OF NEWPORT BEACH
`� BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NO'MVrING ADDRESS)
LOT BLOCK TRACT
2. DESCRIPTION OF WORK f v -i
ESTIMATED $ VALUATION Z 3v ss :� o
StlVtMiV111V>; P@9�0 SPA-Peft-FE*eNPr 0 DRANAG&-e-
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
S
ADDRESS
OWNER'S E-MAIL ADDRESS
V`53
CITY STATE ZIP
CQ- °��
PHONE NO.
`71-(
t4z, ���
323YER
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
C2-1 6s-%
ADDRESS
ENGINEER'S E-MAIL ADDRESS
-2,o TIJ S--17^-1
CITY STATEZIP
PHONE NO.
AYLF- L.L-,..._ Ce- 5 Z �7
7, 3-0
❑ 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
C;J
j2-0/_40OOL,S
No.(4oqcq Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
(? of �UIr✓)�— B/v2( * P
CITY STATE ZIP
PHONE NO.
S'V j T? -7 90
`1 lq SftSs�
OFFICE USE ONLY
PERMIT N0.
PLAN CHECK NO. C/(�
C�� a?lG'I Eli'
POOL P/C FEE $ a�
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls