HomeMy WebLinkAboutS2022-0057 - Permit ApplicationagWPp
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 6 W Il l NG S Q 1!:o . MP-.) GL4 Q 7-1.,,,-A
LOT
2. DESCRIPTION OF WORK
SWIMMING POOL
APW 04q-221. %y
BLOCK TRACT
ESTIMATED $ VALUATION
SPA N,. POOL FENCING ❑
Check Appropriate box for Applicant
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3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
Itv2o IGtN S RD
RS0L-- A -N1@ akW,co
CITY STATE ZIP
PHONE NO.
N 5 e0463zwo-s
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ogats -BIvt>w%6�, �►��-.
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-ADDRESS
ENGINEER'S E-MAIL ADDRESS
Ito1 K,
I ckrisl> kn .co&l
CITY STATE ZIP
PHONE NO.
AwANE► CA- ctZ,607
IN w Wit/
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
KNTtS Gvi.`
Fr3o&qzlS-
No'i?-3'?7Tbass,
ADDRESS
49iI UXTIS
CONTRACTOR'S E-MAIL ADDRESS
5 x11 �h(arcriCA e4mi.
co
CITY STATE ZIP,
PHONE NO.
W 0QAg36E <34-- 4012166"_t
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'71N 4qb t42
;E USE ONLY S ^, L . J 14,1. 40T.
PERMIT N0. •/yfv/' /�/�
PLAN CHECK NO. MID - Q aloof
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls