HomeMy WebLinkAboutS2019-0029 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATI
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CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE'
1. PROJECT ADDRESS (NOT MAILING ADORESs
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORKCb`) Ck-C+<-- J �J YYNA1 i 1'( °� �Cc,' p�
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WIMMING POOL SPA ❑ POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Anolicant
0 3. OWNER'S NAME LAST FIRST
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ADDRESS
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OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
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aro 762 S2sz
. ENGINEER'S NAME L LAST FIRST
LICENSE NO.
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ENGINEER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE CENSE
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No. Class
Class
ADDRESS
5
CONTRACTOR'S E-MAIL ADDRESS
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1406
CITY STATE ZIP
KA 114 cA 12fz(o 3
PHONE NO.
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:E USE ONLY
PERMIT NO.
PLAN CHECK NO. �e���C�•, �j t O� �� 31• Lr�
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xis