HomeMy WebLinkAboutS2019-0157 - Permit ApplicationPLEASE PRINT OR TYPE
LOT
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
(NOT MAILING ADDRESS) _
2. DESCRIPTION OF WORK
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$=p4{v}Ii46'P 0 SPA [!I'
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TRACT
3. OWNENAME LAST 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 TATE ZIPPHONE
9 z `7
NO.
J71�36 3 .ffay'
5. C CTS NA
BUSINESS ^LICENSE
STATE LICENS
No. Class
ADDRESS
`i LAS, 'vim
CONTRACTOR'S E-MAIL ADDRESS
CI TATE ZIP
9a4 _
PHONE NO.
71 <&V,-zl
OFFICE USE ONLY 26 -Tc )fI
PERMIT NO. S LU fa`}V �
26:
PLAN CHECK NO. 35 ° rAj Lfl r��rf,�,,2''2
POOL P/C FEE $ _ a 11V V ✓
DRAINAGE P/C FEE $ � 10 `�✓ (,/ `��
Forms\Pool spa appl (rev3-04).xls