HomeMy WebLinkAboutS2020-0011 - Permit Application_ O l 4l2 20 Zb
k WORKSHEET FOR POOL COMBINATION PERMIT APPLICATIONNP,
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' CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
A�
LEGAL DES RIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK hr,'0446 MEW 4/,9,Yr5 , ,yFw f)2Nin/ r��ir72t
ESTIMATED $ VALUATIONG, 7414-
SWIMMING POOL SPA ❑ POOL FENCING ❑ DRAINAGE ❑
Check Annronriate box for Andicant
3.
OWNER'S NAME
LAST
FIRST
OK.eoW
, OA/
ADDRESS
OWNER'S E-MAIL ADDRESS
S
i'
1,0 4 /rl 0 T/T eD COX.NEr
CITY
STATE
ZIP
PHONE NO.
.112w,aaer
cH
,d
a66 9
954yy
4.
ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5.
CONTRACTOR'S N ME
BUSINESS LICENSE--FS
E LICENSE
CS -3 CAF
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S
N0.$7/1Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
DOU�CAS. HBYLtOfFN0E2
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J96ANSIV 17;V1000L3, eaM
CITY
STATE
ZIP
PHONE NO.
XANa
14
ga a &
71v- b R8 - 9419
OFFICE USE ONLY r
PERMIT NO.y� �� I
PLAN CHECK NO. ejgz, • Z® %,
POOL P/C FEE $
DRAINAGE P/C FEE $
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