HomeMy WebLinkAboutS2020-0163 - Permit ApplicationW °"r WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
rLCNJC vnilmI VR 17rm
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
Z ,\h 5 N0J 0'(a�\ 2 3
LEGAL DESCRIPTION
LOT 41 BLOCK TRACT
2. DESCRIPTION OF WORK 1 V QVII P(SO 1 S p0..
ESTIMATED $ VALUA N -'s 00 U
SWIMMING POOL SPA :Rf POOL FENCING DRAINAGE
Check Aoorooriate box for Aonlirant
3.
OWNER'S NAME
LAST
FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
�? 0 \Yl S 1
24 \n 4 \ L - b 0 yv\
CITY
STATE
ZIP
P ONE Na.'
zw D ac�n
b %
X266
4.
ENGINEER'S NAME
LAST
FIRST
L E E O.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
15.
CONTRACTOR'S N ME
BUSINESS LICENSE STATE LICENSE
IN( _.
'lass
ADDRESS /
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
i
ZIP (PHONE NO.
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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