HomeMy WebLinkAboutS2021-0254 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
(SO f) -D�l
1. PROJECT ADDRESS (NOT MAILING ADDRESS) I
114&�- 6GI4-x-y Drz-
TRACT
DESCRIPTION OF I WORKC
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C(lV7 (Sy"
�%� Z'7Pt '+ 18 (( /�lei9 5 46 bl7A ESTIMATED $ VALUATION Y'T(000
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SWIMMING POOL 0/ SPA POOL FEn7CING [-II ajfi
Check Appropriate box for Applicant
3. OWNER'S NAME LAST
FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
1 66G1e—y-�
CITY STATE
ZIP
PHONE NO.
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64z(.(oo
4. ENGINEER'S NAME LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
TSA k)e—
CITY STATE
ZIP
PHONE NO.
prl^p,,t
q-M&Cq—
".63u-6(.(
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
S� --c
No. W%�P-( Clas�-.
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE
ZIP
PHONE NO.ct
b l
!�' CA-
cj766 3�
Irl-fxo]dlA1
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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