HomeMy WebLinkAboutS2019-0096 - Permit ApplicationCfl C ZLCA -Jv v( Ni,%\v J- \ \ 1 1
OSWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
ZUt� - 00��Q CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE - ` ✓r'VYy! �'V V4""V +
1. PROJECT ADDRESS (NOT MAILING ADDRESS) ,
43 & Y�7 bYrC-L
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK DC7 L £ $?AI - o� �['SSon
— / q( 1%� ESTIMATED $ VALUATION 1.7-01coo
SWIMMING POOL SPA P4991= FEDIC UG -G DRAINAGE-9-
Check
R_nINAG_Er
Check ADDroDriate box for Aaalicant
E] 3. OWNER'S NAME LAST FIRST
ADDRESS
3 C4m*2/4
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
v6l"Poc�- '17r-qcil 6-, �2-6 Z7
PHONE NO.
9�q.5bL, 3 z/ l
4. ENGINEER'S NAME LAST FIRST
0 (_ a L -i
LICENSE NO.
G ll (�7 3
ADDRESS ^
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
o
PHONE NO.
5. CO T^^RACTOR'S NAME//ll
BUSINESS LICENSE
STATE LICENSE
CC
ADDRESS /j _
CONTRACTOR'S E-MAIL)W%
TE ZIP
I",qZ2--
PHONE NO.
(Ilq, W -oS�9
'L
OFFICE USE ONLY
PERMIT NO. "All
�� l
PLAN CHECK NO. IO 1 V ✓ W l l
POOL P/C FEE $
DRAINAGE P/C FEE $
Fortes\Pool spa appl (rev3-04).xls
-7p,v C7° 1