HomeMy WebLinkAboutX2021-2435 - Permit Application; X2021- 2y �6
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
BUILDING DIVISION a9j' � '
PLEASE PRINT OR TYPE -
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
I Ll l :�- �L
LEGAL DESCRIPTION II
LOT BLOCK l TRACT
2. DESCRIPTION OF WORK Jf LO
Of Pr\v\ti / 4- jr:: _!n
SWIMMING POOL lclll� SPA
Check Appropriate box for Applicant
YJ 5Vv6 - "5 b I x \ W Xre ,-
ESTIMATED $ VALUATI 000
POOL FENCING ❑ DRAINAGE El---�
3. OWNER'S NAME LAST FIRST
V4,A l C G ✓L
OWNER'S E-MAIL ADDRESS
p c�AD{DRESS
CITY STATE ZIP
PHONE NO.
VJ1>7t>
C-t`1cl-495
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
k N +ham
STATE ZIP
PHONE NO.
/CCIIT"Y
rlr\j�- JAe�VVI c 0127-a°-+-
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5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
5�-% 1>6015 00�S3K
6�
No.io056HK ss3
ADDRESS
X33 [->,,,G-e 0,- i�-- -q-
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
N ?13 IT7-6 6 3
I-r-ly g 73-1 T-- L?
,E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xis
toM- 6110
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