HomeMy WebLinkAboutE2022-0010 - Permit Applicationocxo
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION �Q��
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)'I' poiz7t
rm
2. DESCRIPTION OF WORK P0o1. PrW D SOA- `086 �%� I 1 6,15 f(j yjq 4-
'E l tC ' & F,glX . /qy p, oy-e-yl S ESTIMATED $ VALUATION -fS-(000 /
SWIMMING POOL 2 SPA I� POOL FENCING [I DRAINAGE Ly
Check Appropriate box for Anolicant
r] 3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME 1 LAST FIRST
LICENSE NO. 6-46"
ADDRESS
ENGINEER'S E-MAIL ADDRESS
[201 tiJ , TU Avg
CITY STATE ZIP
PHONE NO.
PF^Ake I YLA Cf�l- 02
19N 63o- 6(60
5. CONTRACTOR'S NAME
BUSIIN�N,,E��//S``S LICENSEE
STATE LICENSE
v1 �f19 Nr POOLS
3T7� �3N6 I
NoY)09 b�1 l Class33
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
S-33 Do lev 19 v
W 5 �� ootscc�e sG vvt U 0, (o
CITY STATE ZIP,
PHONE NO.
�JPb cA- 17663 jqjjq
:E USE ONLY
PERMIT NO.W�'fI'�O�tl���•fI08�j,
PLAN CHECK NO. 10� W VV �T5
POOI P/C FEE $ ..I
" /C FEE $
�l (rev3-04).xis