Loading...
HomeMy WebLinkAboutS2021-0112 - Permit Application"� ' WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION - X41' CITY OF NEWPORT BEACH S202I-0! 2 PLEASE PRINT OR TYPE BUILDING DIVISION 1. PROJECT ADDRESS (NOT MAILING ADDRESS) /41 LEGAL DESCRIPTION e LOT BLOCK TRACT /Till' Q 2. DESCRIPTION OF WORK f7` a S (gip _ laPe'i'cZeli . � �P©14) S ( ESTIMATED $_, LUATION� s SWIMMING POOL Lw SPA � E POOL FENCING J4 DRAINAGE Check Appropriate box for Aoolicant u- \ 3. OWNER'S LAST FIRST �NAME _I I ADDRESS qSz OWNER'S E-MAIL ADDRESS ,1v{T- 7, t2G9VUP- CITY STATE 21P 19cw odd &7a6A Olt- �aZw& PHONE NO. 9W gz -�WI:2 4. ENGINEER'S NAME LAST FIRST LICENSE NO./ Lqce�zo P61? a�aJC-CP ADDRESS ENGINEER'S E-MAIL ADDRESS /Z/ 4 19 �'7400'� CITY STATE ZIP ONE NO. PI-11-610-61,20 Ca D ❑^ 5. CONTRACTOR'S NAME BUSINESS LICENSE STATE LICENSE Rl j s -obi 12U No. Class ADDRESS CONTRACTOR'S E-MAIL ADDRESS CITY STATE ZIP PHONE NO. CE USE ONLY PERMIT NO. �, 611-2, PLAN CHECK NO..3Z� POOL P/C FEE $ DRAINAGE P/C FEE $ Forms\Pool spa appl (rev3-04).xls