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HomeMy WebLinkAboutS2020-0018 - Permit ApplicationS2e�zU coo 16 �a WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION F� CITY OF NEWPORT BEACH BUILDING DIVISION PLEASE PRINT OR TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) /� .... _. _. _ z z� �� I C�et^ 61 rc LOT BLOCK TRACT 2. DESCRIPTION OF WORK QOL S I' LA ( 3 — 'L F'ar'5'." , 111Z, l" P,T tFA,ecrw c - 0ViGL ESTIMATED $ VALUATION SWIMMING POOL [!r SPA P_nnl ENLUfg DRAINAGE ©-- Check Appropriate box for Applicant 3. OWNER'S NAME LAST FIRST 5 �� Ia ADDRESSOWNER'S E-MAIL ADDRESS el Ze CITY STATE % (l �j !J S(/TA/�TE ZIP / V (l �-1 li.�ZN� LJ� l Z-% GzD PHO�NEE NO.(� j 949, 2 -IJ' 9 I Ci 4. ENGINEER' N ME jj LAST FIRST LICENSE NO. �^ C ((t-0, C0� 1;� - ADDRESS•- - ENGINEER'S E-MAIL ADDRESS CITY STATE ZIP PHONE NO. 5. CONTRACTOR'S NAME Sw AJ �� �s BUSINESS LICENSE STATE LICENSE lNo.4-to33;Class ADDRESS CONTRACTOR'S E-MAIL ADDRESS Z `E S l ?_ t CI rY - � �S , NATE rr ZIP l2��d PHONE Oc. 1 0� Oi�J(7 ;E USE ONLY PERMIT NO, 0 01 �.�� PLAN CHECK NO. Zo 10 POOL P/C FEE $ DRAINAGE P/C FEE $ Formswool spa appl (rev3-04).x13