HomeMy WebLinkAboutS2021-0219 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
'k[YIIYMP
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
$ 0. fir, ' h Am
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK bl l yXZy'w f S/=mo%/I j 114 44
= I\ ESTIMATED $ V1LUA ON
SWIMMING POOL ;g SPA POOL FENCING ❑ DRAINAGE ❑
Check Aonronriate box for Annlicant
3. OWNER'S NAME
LAST
FIRST
SC
aianr 4. Drr}laN
ADDRESS
OWNER'S E-MAIL ADDRESS
jiIh
CITY
STATE
ZIP
PHONE NO.
fi sw (k
ach V
17660
°��/�278 -7
4. ® 4. ENGIN ER'S NAME
LAST
FIRST
LICENSE NO.
btadlb h
1
1mlW r
700.4
ADDRESS
ENGINEER'S E-MAIL ADDRESS
Zn 1 IV• 705 1,
Ate
CITY
STATE
ZIP
PHONE NO.
f4va erne
C/*
'MS)?
17111-iW-000
E&5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
,I K %
7—
i%G • y
No. 6/w Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
lb - V4
CITY
STATE
ZIP IPHONE
NO.
�an „c�-
7Y701
7/y 3?3 -630;4
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa app[ (rev3-04).xis