HomeMy WebLinkAboutS2019-0120 - Permit ApplicationS2,/Olcl - 012-0
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LOT BLOCK
2. DESCRIPTION OF WORK V U V) I' �. S
SWIMMING POOL ❑ SPA
Check Aoorooriate box for Aoolicant
ESTIMATED $ VALUATIONTl —
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
C tj ler V k mon 6 cq
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
I CA. Z5,
PHONE NO.
ro kia die ►MAR Z
4. ENGINEER'S NAME LAST FIR9T
V)!- ovl la - + h �v n� vi
LICENSE NO.
0011 L�
ADDRESS IFro
( � P ►J Tu s�- ►�
NGINEER'S E-MAIL ADDRESS
PD &, as f "Ilrocr. A)
CITY STATE ZIP
PHONE NO.
X50 (0104
5. CONTRACTOR'S NAMES (� � b - I
N
BUSINESS LICENSE
STATE LICEN?S�,F ..
�Cla'ss/
A^uew lL !�
NoCA3
ADDRESS
rld sr'
CONTRACTOR'S E-MAIL ADDRESS
o6ol V�toy\vt.f0l
CITY STATE ZIP
\ CA'p'
PHONE NO.
! 3-) X36
OFFICE USE ONLY
PERMIT NO.
1 bL
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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