HomeMy WebLinkAboutS2020-0015 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
` CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
2 0 12), ova
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK PO'ZA ati �^ �'� S �� Spy
y7 5'S 3y Q 5� h�� ESTIMATED $ VALUATION ���
SWIMMING POOL [ SPA-] POOL FENCING ❑ DRAINAGE ,X
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
-t• �_ S�- 2i
1 c, Cp,
ADDRESS
OWNER'S E-MAIL ADDRESS
2 'i m-z,A SA
�\Z6�3
CITY STATE ZIP
PHONE NO.
N �Z,A- Ll.
-114 2�oq y i 3
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
-TK�Oj3,
boJi I
ADDRESS
ENGINEER'S E-MAILADDRESS
\
1 , NY • I'M , Y-,
CITY STATE ZIP
PHONE NO.
-71�I-
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
00
ADDRESS -
CONTRACTOR'S E-MAIL ADDRESS
b� \--jv\c\ &r r- :'VZqo
CITY STATE ZIP
PHONE NO.
1rvt, G� °�2ioo
�H-� 3-71 L139
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO,
POOL PIC FEE $
SzoZ0 -0( 1S
o 11 -� -ao 2-C)
DRAINAGE PIC FEE $
FormslPool spa appl (rev3-04).xls