HomeMy WebLinkAboutX2020-1429 - Permit Application (2)4714
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WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
(� C 0>1�
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Ke toc, Y -C
SWIMMING POOL X SPA ❑
Check Appropriate box for Applicant
X200 • !14119
_ ESTIMATED $ VALUATION 6ovc'oc
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
Gee o/m L _
ADDRESS
%A� CD(/ V71 t iL"I o'
OWNER'S E-MAIL ADDRESS
C--6�'o, T,114,1 & ) ✓�y-en/rvec% �. G0
CITY STATE ZIP
.�� r c76U o
PHONE NO.
6w6-3uf-o7
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
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
CE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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