HomeMy WebLinkAboutS2020-0013 - Permit Application (2)S vU 00 ► 3 z�S 0 v
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION.
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
L1600 RU PW P- D RD CO -DNA pG L- MA R I eH q,�Lud-_S
LEGAL DESCRIPTION
LOT BLOCK TRACT 3
2. DESCRIPTION OF WORK Ldldgoo I Y Low' goo
1'2. CAA55vxfr5. ESTIMATED $ VALUATION
SWIMMING POOL Eg SPA ❑ POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME
UTT-
FIRST
AP
ADDRESS.
OWNER'S E-MAIL ADDRESS
,Uq PRWSTDNF
I rDwSkvgplo
qm4l I. cowl
CITY
STATE
ZIP
PHONE NO.
j rU i n,
C.*:1
gguo 3
E] 4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
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AmIr
ADDRESS
ENGINEER'S E-MAILADORESS
31�a laza Pol>1+e
v. It15
arnirpcoresrrwe-fore . coni
CITY
STATE
ZIP
JPHONE NO.
La >tiv16 41lfs
e I4
ga-o63
-1 q-qsy--7ayq
5. C TRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
VAVC Cl RGA C IENEP-P L- (� uj Lol )u
No.5a` ISE) CIasS l3
ADDRESS
CONTRACTOR'S E-MAIL
ADDRESS
31�af� o
uta 08
i4avc1 davtd
yl t1ba -com
CITY
STATE
I ZIP
IjRONE NO.
,k Mwl
'0(M5
qLa-a-1V-bLilb
OPFlG USE ONL
PERMIT NO.
• I1�" rV%o
PLAN CHECK NO.
/
POOL P/C FEE $
Z Y
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DRAINAGE P/C FEE $
FoanslPool spa appl (=3-04).As