HomeMy WebLinkAboutS2022-0037 - Permit ApplicationNF 5rn@
F r WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
f rn„ CITY OF NEWPORT BEACH 52022- 003
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
Or
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTIO//N OF WORK
IN S9rohL �eCgTlesl QSrtcF
ev-r4 f
SWIMMING POOL L—y/
SPA
Check Appropriate box for Applicant
and Crwsf/ac-Acs s��7cPc {c Paa/
ESTIMATED $ VALUATION �loO� Oo a °=
POOL FENCING ❑ DRAINAGE Ly
r] 3. OWNER'S NAME LAST FIRST
J otfvf'a.✓ Le o
ADDRESS
OWNER'S E-MAIL ADDRESS
7o r
CITY STATE ZIP
PHONE NO.
l7elwA f f 6eG CA '74 6 v
9Y -37o - Iz Z
4. ENGIN R'S NAME // LAST �FIIRRST�L—
LICENSE NO.
ADDRESS I
ENGINEER'S E-MAIL ADDRESS
lab 41e.17,7. 04 417
CITY STATE ZIP
PHONE NO.
%a�e�� 614�a7
630
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
QAME
S-4 / (315
hr-- 3oos3t6r
iNof67770 Cass 3
ADDRESS
�orS #
CONTRACTOR'S E-MAIL ADDRESS
36 00 S 3
J/�P7SP"/S(E-3'wo(/.Gom
CITY STATE ZIP
PHONE NO.
/&07L I I Ali Isect& CA Z6 6 I
7/ - Zo-,rY73
'E USE ONLY e7 PERMIT NO. 0
PLAN CHECK NO.
POOL P/C FEE $
iy� % ���iy
DRAINAGE P/C FEE $ 6` qky- t "`'
Forms\Pool spa apps (rev3-04).xls