HomeMy WebLinkAboutS2021-0141 - Permit ApplicationSzoL I - \ 6-1 q t
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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' CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
1 �,�o PUr<-�'
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK f �er fr Lz P rc-�oLLj eA- ( P-efIr.CC 4,7�' ,S , fb6�� ��
KQf I4Ce �-y �, (12P/ (f--e pl-t--(I C6ve� ESTIMATED $ VALUATION O0 0
r11S-/s/i 33Q /zul 5,i.3 `f0 3i3CZ
SWIMMING POOI.4�7 SPAe7 POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME / LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
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�s� �.T_</� isa.c 9°�'14.'f Cam
CITY STATE ZIP
PHONE NO.
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4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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Now%94 Class
ADDRESS /,(
CONTRACTOR'S E-MAIL ADDRESS
STATE ZIP
CITJY/
PHONE NO.
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`l/
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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Forms\Pool spa appl (rev3-04).xls