HomeMy WebLinkAboutS2020-0020 - Permit Application (2)WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
2 LL4 V /r BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
r-j-- 66G[-\
LEGAL DESCRIPTION (�
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL ❑
SPA
Check Appropriate box for Applicant
ESTIMATED $
POOL FENCING ❑
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S tPME
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SPAnDsk� JO�F� t� v n too 1 �JV I � Oa trj
1
BUSINESS LICENSE
TATE LIC
SENSE
Noo..2�Ji� (JLf
Class C,
ADDRESS
32-(c>L LaIle-DPI I �soro
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
s,-� 0CAv1 CcIS�Y4koo c A 12b75-
PHONE NO.
7q�- 2/- 33(4
OFFICE USE ONLY
PERMIT NO. � Zl .. oo ` o
PLAN CHECK NO. �' �� W70t
P/C FEE $
RAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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