HomeMy WebLinkAboutS2019-0066 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
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09n101 _nfY 1)l1)
PLEASE PRINT OR TYPE v'L"L 1 �/`•C
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
241 9 �, �
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK vc�c;�n\\ m�-ecA zz CA
ESTIMATED $ VALUATION 0, C>CD CD
SWIMMING '••LX IO ••• DRAINAGE■
Check Appropriate box for Annlicant
3. OWNER'S NAME LAST FIRST
L
ADDRESS
OWNER'S E-MAILA DRESS
Z p Av
CITY STATE ZIP
PHONE NO.
4. ENGI ER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
cA\,Yl\
CITY STATE Z
ONE NO.
L -z O"1
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
J° �—'
No. '6-lln Class Z
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
2)0-1 povy
Q�\?YbSGCkve-SQb-vul0O0. Lb T"I
CITY STATE ZIP__]
PHONE NO.
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;E USE ONLY A n
PERMIT NO. 59101 dO�Ot'o
PLAN CHECK NO.
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POOL P/C FEE $
DRAINAGE P/C FEE $
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