HomeMy WebLinkAboutS2020-0074 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
1.20
CITY OF NEWPORT BEACH.20
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
t NC.P6 1 CVN— of -Z
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK ?0Q 1 C1. ftA 0 �- l w NJ i VJ 0 °l L4 ff I 6c,5T' W9
C'µ S 1 \✓i D�` / L� C +0 ` ® ESTIMATED $ VALUATION
SWIMMING POOL Ly' SPA �]' / POOL FENCING ❑ RAINAGE
Check Appropriate box for Analicant
3. OWNER'S NAME
LAST
FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
p
l m `PC, )
CITY
6t
STATE
ZIP
'1�(,bo
PHONE NO.
twP��"
c-
cam-
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
13 If
C7L �f c
��✓I S
`e ✓
�dO
ADDRESSER'SE-MAIL
ZA
� o1 �v5�^� e-
CA-
ADDRESS
CITYi
�nG kt k vo
STATE
ZIP
PHONE NO.
5. CONTRACTOR'S NAME
rj
�6 �C-
BUSINESS LICENSE
'�
STATE LIC/EN{SE / c
.'�j-1✓L
Ci
�%'�
(1 ��J`� Ei
No. 1 CkLIl O� lClas�� )
ADDRESSv y'Yy
` ()
CONTRACTOR'S E-MAIL ADDRESS
CITY
P5
coot
STATE
9760-5
ZIP
1
PHONE NO.
aka �Q`i-w-CWK -
USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
X111 I DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls