HomeMy WebLinkAboutX2020-1123 - Permit Application (2)a
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH^ X,1620-11 S
BUILDING DIVISION
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1. PROJECT ADDRESS (NOT MAILING ADDRESS)
1949 Pd.,?r ldlqv 9,-,264o
BLOCK
2. DESCRIPTION OF WORK GUGD6&17'OM 304
ESTIMATED $ VALUATIONS/d dO DD
SWIMMING POOL ❑ SPA POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
ADDRESS
E-MAIL ADDRESS
qOWNER'S
/,95"7 —C -4K '
CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME 1 As FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
1
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
:E USE ONLY
PERMIT NO.
PLAN CHECK NO. `2uJ` G(of: o
POOL PIC FEE $ �
DRAINAGE P/C FEE $ -P2 (J�
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