HomeMy WebLinkAboutS2020-0148 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
c, ,)tUSI
PLEASE PRINT OR TYPE
1 ROJEC DDRESS (NOT MAILING ADDRESS)
(� �i'.�s
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF
SWIMMING POOL ❑
Check Amrooriate box for ADolicant
(►t2,
ESTIMATED $ VALUATION
POOL FENCING ❑
DRAINAGE ❑
12/3. OWNER'S NAME -17 �) LASTFIRST
kz o�� civ �/'f
DRESS &�-
r�— P 5�
OWNER'S E-MAIL ADDRESS
CT �STATE /AL1, ZIP
iv l%s-'6UAQciE-r �f s
PHONE NO.
4. ENN EER NAM LA/ST RST
-
LICENSE N0.
e LL L
ADDRESS
ENGINEER'S E-MAIL ADDRESS/
`
f L (////
�n _CIT'Y STATE IP
�"G�#G d
PHONE NO
?1?,- Z6 o co
[2r5. CO TO S NAME
BUNS LICENSE
STATE LICENSE
r e.0Z/ .
i
ADD SS f
CONTRACTOR'S E-MAIL ADDRESS
CITYSQNE
T� ZIP
P�������Q��
OFFICE USE ONLY �`,��
PERMIT NO. KJ7�� • C! I ` 2) ub� �!61 �O S
�ff11 I -
PLAN CHECK NO. �'� -I— 7i0 7"6
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls