HomeMy WebLinkAboutS2019-0054 - Permit Application(9)
PLEASE PRINT
LOT
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION S�19' oo 5"4
CITY OF NEWPORT BEACH
BUILDING DIVISION y �j
(NOT MAILING ADDRESS)
L2*SCRIPTIO O WORK
MMING PO L
Check Appropriate box for
3. OWNER'S NAME
ADDRES
CITY
4. ENGINEER'S NAME
_ ESTIMATED $ VALUATION
POOL FENCING ❑
OWNER'S E-MAIL ADDRESS
4.00ALiM6L.(<.Ip14tVN00 @C*AUgjL,•totl
)TATE ZIP FPHONE NO.0� �2(00o 0.liq-FIRST ENSE NO.
ur PHONE NO.
5. CONTRACTOR'S NAME BUSINESS LICENSE STATE LICENSE
��i ��� No. ��Z9S Class �s
ADDRESS CONTRACTOR'S E-MAIL ADDRESS
hI Ana fl—
CITY STATE ZIP PHONE NO.
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
t v
DRAINAGE P/C FEE $ 1 _
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Forms\Pool spa appl (rev3-04).xls