HomeMy WebLinkAboutS2020-0191 - Permit ApplicationPt wnr
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH 5.20,20-0/q�
BUILDING DIVISION
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1. PR ESS( i \1 AILS ADDRESS) (A_ ki
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LEGAL DESCRIPTION
LOT BLOCK
TRACT
2. DESCRIPTION OF WORK_KL�y
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SWIMMING POOL.0 SPA
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_ ESTIMATED $ VALUATION -3-1160-0
POOL FENCING ❑ DRAINAGE ❑
OWENAME LAST
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FIRST
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AD
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OWNER'S E-MAIL ADDRESS
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CITY STATE
ZIP PHONE NO.
4. ENGINEER'S NAME LAST
FIRST LICENSE NO.
1
ADDRESS
ENGINEER'S E-MAIL ADDRESS
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ZIP
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5. CONTRACTOR'S NAME
BUSINESS LICENSEE
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CONTRACTOR'S E-MAIL ADDRESS
CITY STATE
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ZIP
a'G77�
PHONE NO.
2,,14oV7
CE USE ONLY
PERMIT NO.
PLAN CHECK NO.
21� CI' 'Lo2o
POOL P/C FEE $
DRAINAGE P/C FEE $
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