HomeMy WebLinkAboutS2022-0015 - Permit Application (2)Htwro' WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
U� \iO i
µ . CITY OF NEWPORT BEACH
BUILDING DIVISION 5%o22-�h1�
PLEASE PRINT OR TYP
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
51 U /rig(/ d5 %l o A.D
LOT
2. DESCRIPTION OF
SWIMMING POOL L�
BLOCK
TRACT
y 'POOL ';V Nof
ESTIMATED $ V,
SPA ED/ POOL FENCING ❑
Check Annronriata hnv inr Annlirmn*
,?0; Obb
DRAINAGE ❑
3. OWNER'S NAME
LAST FIRST
J ,-J S O0.(
/ Y,/ E Y
ADDRESS
OWNER'S E-MAIL ADDRESS
57/0 /JN6S i2aA
Py(dYHJ/o9.con
CITY
STATE ZIP
PHONE NO.
Al- -ewpv/"f
-8 e <"I 7Z GW 0'
(9y°1)290 -`7`l%
4. ENGINEER'S NAME
13! �!�1.8A
LAST FIRST
CN S1Op¢fcl
LICENSE NO.
C I
7 yoo3
ADDRESS
AV e,
ENGINEER'S E-MAIL ADDRESS
C/}�IS/3� �Ovl�i/GP �O
CITY
STATE ZIP PHONE NO.J'
I--'AIAY/'1
Cif g2 SU, (-Itv) (.30-&J,00
5. CONTRACTOR'S NAME
BUSINESS LICENSE I STATE LICENSE
S'CavyAAZ
910-7525 cs;
ADDRESS
No. Class
CONTRACTOR'S E-MAIL ADDRESS
CITY
Sa�/7�
STATE ZIP PHONE NLL— O.
&11q CA 927 % 7���O7Z., 0v
OFFICE USE ONLY
PERMIT NO.
,^ raw
1 —
Ni l>,
PLAN CHECK NO.
i
POOL P/C FEE $
Jd(- le
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).x1s
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