HomeMy WebLinkAboutS2021-0098 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH 52,, 02 00
BUILDING DIVISION
rLCNJC rR11Y1 VR 1 TrC
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
BLOCK
TRACT
2. DESCRIPTION OF WORK PIC— t -k \
ESTIMATED $ VALUATION
SWIMMING POOL ❑ SPA POOL FENCING ❑ DRAINAGE
Check Appropriate box for Applicant
3. OWNER'S NAME Ltt LAST FIRST
'1 ILL.
ADDRESS
OWNER'S E-MAIL ADDRESS
y
CITY STATE ZIP
PHONE NO.
c
V
4. ENGINEER'S NAMELAST j( FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
Q
CITY STATE ZIP
IPHONE NO.
P�^ c �^� K l Cdq-- `� (_�&cq
63U 4,16 c5
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LLICEN SCEl
^Am51PI-"
r_lr.V6'5_3LlG0l
16M'4'3
No. assS
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
nn
CITY STATE ZIP
PHONE NO.
CA-
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls