HomeMy WebLinkAboutS2021-0279 - Permit ApplicationWORKSHEET 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)
.5i
LEGAL ESCRIPTION
LOT BLOCK TRACT
[E2.ESCRIPTION OF WORK�I�/��r jai f-/I/<lgw -AlESTIMATED $ VALUATION 2Dil�DO_-
MMING POOL SPA POOL FENCING ❑ DRAINAGE
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Check Appropriate box for Applicant
3. OWNER'Sj-NAME �/ LAs FIRST
ADDRESS - OWNER'S E-MAILADDRESS
J'
31TY ® d' (/®' C� i
�y-STATE ZIP PHONE NO.
SQ LJ (9 iJ`f nom' �2(0�
4. ENGINEER'S NAME LAsr FIRST
LICENSE NO.
ADDRESS ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP PHONE NO.
5. CONTRACTOR'S NAME BUSINESS LICENSE STATE LICENSE
SesSe �:�o �3q
ADDRESS No. Class
CONTRACTOR'S E-MAIL ADDRESS
ZD �1eS� V�h� i�►^ �o1vd. Lunajesse-116) a ,00. eom
CITY STATE ZIP PHONE NO.
� r G4 �'v631 �2�4oa-yy
OFFICE USE ONLY
PERMIT NO. 5-Z-7 l F20ZI - DqjlpZ zI-i�Sr- I
PLAN CHECK NO. 3 3 S �! `
POOL P/C FEE $
DRAINAGE P/C FEE $ ASO
Forms\Pool spa apPI (rev3-04).xls