HomeMy WebLinkAboutS2020-0080 - Permit Application+" °le WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH 0704&)
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT /AADDJDR/pES(jS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION7--
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATION j z`')o coo
SWIMMING POOL Jj SPA jg POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Anolicant
3. OWNER'S NAME vsT FIRST
ADDRESS
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OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
GA- 7Z62-5
PHONE NO.
6 3,
10- -73
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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C�Y00-
ADDRESS
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ENGINEER'S E-MAIL ADDRESS
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CITY STATE ZIP
ONE NO.
9Z93°c,
6100 1
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
, 3 _
No. a 91) Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
CE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls