HomeMy WebLinkAboutX2020-1123 - Permit Applicationa
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
x t.620 -112S
CITY OF NEWPORT BEACH
BUILDING DIVISION
MCA=rRINI VR 1irC
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
BLOCK TRACT
2, DESCRIPTION OF WORK GZ) J1
ESTIMATED $ VALUATION"'/VO
,000,00
SWIMMING POOL ElSPA POOL FENCING E3DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME
LAST
FIRST
3 e. �,, 4,, A, -4 e�
/talow
%? e-^
ADDRESSOWNER'S
E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
'i f'c C- a
926 G
4. ENGINEER'S NAME
LAS
FIRST
LICENSE NO.
1 p
t y
ADDRESS
ENGINEER'S E-MAIL ADDRESS
t
CITY
STATE
ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
rlt,- MAI A
�
L
V 2/ (L
bJ/ a
ti
NT"l Claas-`l
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
OCG, ZL
-b �-") 3
:E USE ONLY 7
PERMIT NO.L '` C
PLAN CHECK NO. �2 ' 262o
1.
POOL P/C FEE $ � > �
46 r-4
DRAINAGE P/C FEE $ (1` Q
Forms\Pool spa appl (rev3-04).xls ,� ,� /� 201