HomeMy WebLinkAboutS2020-0006 - Permit Application (2)o��e'Wr"Rr� WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION SZOZU'-aDUID
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CITY OF NEWPORT BEACH
BUILDING DIVISION
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1. PROJECT ADDRESS (NOT MAILING ADDRESS)
2100 r.. Ba -.\boo.. dov\e-,/o,A
LEGAL DESCRIPTION
LOT 4 BLOCK TRACT PM k 1 L}
2. DESCRIPTION OF WORK ga. c�;n_42yopTf_TPer
CP at,AtLl Pe-onn'i V H • s ESTIMATED $' VALUATION (v I3pO
SWIMMING POOL ❑ SPA El' POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST Go FIRST
VCL. 1 \Ou52. Z\00 L L.G
ADDRESS
OWNER'S E-MAIL ADDRESS
2021 E3. go-� A,,/9 -nue
�54,ouar®ecu pio nn;r,g.com
CITY 7§TATE ZIP
PHONE NO.
blew oV4 Cm . 9 z(�<o 1
Ccv-m) 5t,% - zasa
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
J.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
18321 ve��La�-a 13�.,a., su;ke (015
CITY STATE ZIP
PHONE NO.
-ra-r- t3..n o.. C.A. 913b b o
( $) a?, 6.5 4
F15. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LIC NSE
fan e} 6u; \nc .
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
06,je, L\ri�} 6
l�,ev;.,bQ.rrekbuns-C-om
STATE ZIP
LCZC,'r!20-""
PHONE NO.
CA 9!)CYU
(bc>b>5:5 50 -IS
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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