HomeMy WebLinkAboutS2021-0079 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
a' CITY OF NEWPORT BEACH
BUILDING DIVISION 920011v'oolm
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK ,4100 L J�/� l S C7 1- cl
ESTIMATED $ VALUATIONf 'ST. 000, UO
SWIMMING POOL SPA POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Aoolicant
in 3. OWNER'S NAME LAsr FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
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PHONE NO.
r1
C,0�- 7 Z1,75:L
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4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
6
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP`
ONE NO.
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17i G36.10iaa
5. C NTRACTOR'S NAME
BUSINESS LI ENSE
STATE LICOENSE
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QQ
N U�i67 [® Class5c,
ADDRESS
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CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
lu 44 rnaL 04470lva
, 75(0
'lCE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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