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HomeMy WebLinkAboutS2021-0041 - Permit ApplicationTR WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION CITY OF NEWPORT BEACH BUILDING DIVISION PLEASE PRINT OR TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) /SW (7AG✓1xy Pe -- LEGAL DESCRIPTION LOT BLOCK TRACT 2. DESCRIPTION OF WORK bftxt a r4Jhl?j 0/12JicI T."/- 171-0 rn 'ee o i CIN a(' 5-"44/t, r ,��4J�tf 7 1 71-r- ESTIMATED $VALUATIONZJ ID -11 ®a SWIMMING POOL Er SPA POOL FENCING ❑ DRAINAGE Chack Annrnnriata hex for Annlicant 3. OWNER'S NAME LAST FIRST i /i -e# D clenn F�72— ADDRESS//'� OWNER'S /E-MAIL ADDRESS /J–o� (7/n-4'A'Y 04- ✓Pnr�►ifcii �aQ@ vioo.0-oAA CITY STATE ZIP A,400ti7— 6rACL PHONE NO. Fz(opz read -8/7-2697 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 pJ' P6/s ' JflVl © k �oLthPU C/-( °/IN30053/6/No.90176 CIass ADDRESS CONTRACTOR'S E-MAIL ADDRESS jjmf)4aolf(?1,7MaixA /?3(0/ CITY STATE ZIP //Z4,r74479�O.7 eQ�� Pff- yzzY6 PHONE NO. 71r—YLo-JX73 :E USE ONLY PERMIT NO. PLAN CHECK NO. POOL PIC FEE $ DRAINAGE PIC FEE $ Forms\Pool spa app] (rev3-04).xls 030 j_ Zdz/