HomeMy WebLinkAboutS2020-0051 - Permit Application,��` °°8 m WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
V + .o. CITY OF NEWPORT BEACH /
BUILDING DIVISION 62020 W OD5 t
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF
m
X< �7) e SP/1
ESTIMATED $ VALUATION l Leo 0
SWIMMING POOL D- SPA L3' ❑ DRAINA6E-�Z--
Check Annronriate box for Aonlicant
❑ 3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CIT / STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONT�/ R4C�.:Q�R'S NAME
G/
BUSINESS LICENSE
STATEG�CENSE
Na.� /l L Class
CONTRACTOR'S E-MAIL ADDRESS
EeADDRESS
STATE ZIP
G C 9
PHONE NO.
7W4G4 3s2,6
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa app] (rev3-04).xls