HomeMy WebLinkAboutXR2023-1128 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT --7- 2� BLOCK TRACT
2. DES CRIPTIO�mNOF WORK XM'3 Fli*z %�7-iZ- &ItIol gJ � r4%�f3f�VAj a%— Namv
GV/�tx)tyfce ((� SGi'0'n/6 nESTIMATED $ VALUATION
�'I�'rt'�7�'�iv� cr �r�� C�UC�f�%��lz� v✓r l/C') �rrr+SS�_?�r�"�t�i�o�ly ®r\l�,
SWIMMING POOL ❑ SPA, ❑ POOL FENCING ❑ DRAINAGE ❑
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Check Appropriate box for Applicant
3. OWNER'S NAME FIRST >
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s�/' / v/ie
Y-
ADDRESS/
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
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e b, 3t,m' / ' � i ' 6 •� 2, —
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4, - 4,I PfE ^f&NL4 E— rJn���� LAST FIRST
LICENSE NO.
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ADDRESS
E�-MAIL ADDRESS
&i(5 1�(1%� if i�'�l /
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�f CITY STATE ZIP
PHHOj NE }NO. /6
❑ 5. /_=Na,lcy
BUSINESS LICENSE
I STATELICENSE
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No. f Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
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70) n-7- `(6qS
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls