HomeMy WebLinkAboutS2020-0182 - Permit Application04 �¢WPOk @ WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
r, ?�, p� At n
n„a,,' CITY OF NEWPORT BEACH
BUILDING DIVISION
1. PKUJtU I AUUKtbb (NOT MAILING ADDRESS)
�`► S' Tcu-i-i n Ave
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK 5wl earl J-- ? I
--- p
/ ESTIMATED $ VALUATION(U ��
SWIMMING POOL SPA,} POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
l qrre—rF Nlg i I J- G��I
ADDRESS
OWNER'S E-MAIL ADDRESS
]
�ys Ti6�-In /'f uC
56:1 barren 33 ®G'-wwk. l •Carp
CITY STATE ZIP
AN qar � 36q . 9Z6p
PHONE NO.
0mc, - (OZ3 -
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
n nccr►,n
ro-1(a196
ADDRESS
�-
ENGINEER'S E-MAIL ADDRESS
�r,�® (�u�lev,Jc. mow.
ITY STATE ZIP
na he I vv�
PHONE NO.
63 c, _ b IcX
5. CONTRACTOR'S NAMES �S
Piz, /� 1/
BUSINESS LICENSE
STATE LICENSE
/
No. I Clas
ADDRESS
31 -IIS lci �c 1�cxs�3►t
CONTRACTOR'S E-MAIL ADDRESS
�Q i'erx►n?0jis y ham, �o w.,
r a
(t
CITY STATE ZIP
PHONE NO.
I rn¢c�Jb, �g 9+Z
q51-zSs—�-1tlS
X USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
szozo - 0 19-) 2-
Zol l W
Forms\Pool spa appl (rev3-04).xls (j
Of