HomeMy WebLinkAboutS2020-0183 - Permit ApplicationPLEASE PRINT OR TYPE
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH �) Zp Z® p- ®e g s
BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
(20%O!� Wheel uC
LEGAL DESCRIPTION
LOT BLOCK TRACT Q �J
2. DESCRIPTION OF WORK
SWIMMING POOL K SPA
Check Aoorooriate box for Annlicant
dd l £` o z I -I-
ESTIMATED $ VALUATION o00.0`6
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME
LAST
FIRST
1/
! +
ADDRESS
OWNER'S E-MAIL ADDRESS
40 0,14-
Plat°
CITY
STATE
ZIP
PHONE NO.
,A/e--- d ac%
64
D
qqq, sc2- y6gj
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESSENGINEER'S
E-MAIL ADDRESS
120( a�l �'I/-
CITY
STATE
ZIP
PHONE NO.
a
C
27
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATEICENSE
leella
Gs�r2�
N Class GY
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
S . Sd t./oocl
At
� A64,,44 Qe4neoau0
CITY
STATE
ZIP
PHONE NO.
�
G>e
1-760-M-fOOC)
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO. 'S 1'� l — (�( �� Q t) I
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
100(1
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