HomeMy WebLinkAboutS2021-0083 - Permit Applicationco F3
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
` CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
(7 3/ fv-h �3a,/��7,f P4 6t -
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL ❑
Ae (PIA -C
ESTIMATED $ VALUATION C-� C' L)
SPA POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
I 13 �* Dow/vA
ADDRESS
17 j �v/ Lv� i9
OWNER'S E-MAIL ADDRESS
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S j. 7/j ��S f�CSIgLfF ➢�6}ri4.rf co y
CITY STATE ZIP
PHONE NO.
IVB �f c`eo C4 266
-fq,-2oC)-��93
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS ----T
NGINEER'S E-MAIL ADDRESS
CITY STATEZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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71-4. F4'kd ® AZPAX- ,-y,-f f port, c�h
CITY STATE ZIP
PHONE NO.
OP—ANvkC 2o6i
2 ob2 �5-3• /0?2
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls