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S2022-0161 - Permit Application (3)
S 2022-O M ,.�$wp° WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION e p9 , CITY OF NEWPORT BEACH BUILDING DIVISION PLEASE PRINT OR TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) - ZAff /w, cfllm Gyre LEGAL DESCRIPTION LOT BLOCK TRACT 2. DESCRIPTION OF W-ORKK6e4E�i�q?, Lt_"I IV --Y le L( dgA a /YWr. 4>���JAGCCe jn cWtV51, � �7Vy1 y� Egj ✓L6GBall�ib ESTIMATED $ VALUATION��7d SWIMMING POOL Yf SPA © POOL FENCING ❑ DRAINAGE ❑ Check Anoronriate box for Annlicant 3. OWNER'S NAME LAST FIRST ose �e ice e /2m, ADDRESS Alae v►, (�.�e OWNER'S E-MAIL ADDRESS A CITY t-¢- eeeu4 STATE 41- ZIP TZP7 PHONE NO. - 3- 46611 ❑ 4. ENGINEER'S NAME LAST FIRST LICENSE NO. ADDRESS ENGINEER'S E-MAIL ADDRESS CITY STATE ZIP PHONE NO. 5. CONTRACTOR'S NAME (,S.y g/w#h 140a701S BUSINESS LICENSE STATE LI ENSE 5711 a No. Class 2Z ADDRESS du. G"wio� Ave CONTRACTOR'S E-MAIL ADDRESS �ain�Pl c�a0 a/ahSmN�i 4- CITY STATE 410� ZIP 9046-7 PHONE NO. 1714 -1iW_os ;E USE ONLY PERMIT NO. PLAN CHECK NO. POOL P/C FEE $ r DRAINAGE P/C FEE $ Forms\Pool spa appl (rev3-04).xls