HomeMy WebLinkAboutS2021-0065 - Permit Application"""�R> WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
"'°"` BUILDING DIVISION
PLEASE PRIN I UK I xrr
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
/oz- A P,6(('PCL,Affc)
2. DESCRIPTION OF WORK,
SWIMMING POOL ❑
(CIS �-en^ S
9- A licant
TRACT
ESTIMATED $ VALUATION` 2 -f c1U C1
POOL FENCING ❑ DRAINAGE ❑
b
cnOCK Appropdwe ox r pp
LAT
FIRST
3. OWNER'S NAME
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i2 < c- e;�� M IP� j,04
ADDRESS
OWNER'S E-MAIL ADDRESS
�b 2C(�ECITY Lj� a
STATE
/)-
' /ZIP PHONE NO.
4. ENGINEER'S NAME LAST
FIRST LICENSE NO.
6-7 (�
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE
ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
17,ZA�i ('"")17� e�L-S
N P//o/ 6 Class '
-CONTRACTOR'S
ACTOR'S E-MAIL ADDRESS
4th v SA -)"A (,0"4-
2-2— 7 6A R(e-1-dL-7 /1-�
6
CITY STATE
ZIP
(; Z2 e6
PHONE NO.
od' 2
-E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls