HomeMy WebLinkAboutS2021-0169 - Permit ApplicationvvuRnanee I PUK FOOL COMBINATION PERMIT APPLICATION
M.I
CITY OF NEWPORT BEACH
PLEASE PRINT OR TYPE BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LOT
2. DESCRIPTION OF WORK P.-r(`'S-'c ?C�C'L
7-- LCLC �� Due
ESTIMATED $ VALUATION
SWIMMING POO SPA POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
ADDRESS/
OWNER'S E-MAIL ADDRESS
20 lc>d1<-�
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X33-r(.C„
CITY STATE
C _tC C
ZIP PHONE NO.
pro *;,rc-(-d2y -9�('�Y
E] 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
ADDRESS
No. Class
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE
ZIP PHONE NO.
:E USE ONLY
PERMIT N0,
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls