HomeMy WebLinkAboutX2020-2612 - Permit Application (2)WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH Z0 7-0
z.eS✓*p
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
/c7 � �• l 1 O-"J�7 h'G:LCr � nJ
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATION v DK
SWIMMING POOL SPA ❑ POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Aoolicant
3. OWNER'S NAME LAST FIRST
—(,�za--� 1' w
ADDRESS
OWNER'S E-MAIL ADDRESS
Z nJ
CITY STATE ZIP
PHONE NO.
/ r-vj f7 --:T c>4'
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE STATE LICENSE
ALJ gAj0
cJ?l3nF,
�j3T ,3nDe.6, ��� No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
/ °%
JC, ��-z Q -7i (IGP >//l�o Com
CITY STATE ZIP
PHONE NO.
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL PIC FEE $
DRAINAGE PIC FEE $
Fo"slPool spa appl (rev3-04).xls