HomeMy WebLinkAboutS2021-0100 - Permit Applicationp4 NEVpR'� WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION I
CITY OF NEWPORT BEACH S2o2I'Ol UD
'IGIpIl4PT S
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
IS32 L-,F6L �Wj5- C 6zQnrEt � p�A,4e rd c17�2s
LOT 61 BLOCK
2. DESCRIPTION OF WORK t `mot
SWIMMING POOL X SPA'
Check Appropriate box for Applicant
TRACT 61.5
ESTIMATED $ VALUATION
POOL FENCING ❑ DRAIRAGE 14
3. OWNER'S NAME LAST FIRST
L,4u'e.A 4�4�
ADDRESS
OWNER'S E-MAIL ADDRESS
/S32 ALrez. �DFtvc-
cry
CITY STATE ZIP
PHOflt NO.
6942--�N/l' AR 64 ?N62
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS u
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE C53
No.725/7 Class u
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
2G4S1 VIS74 TeP-I2-4C5- sT 3
/4iaa✓ kccs (.ors h,�•
CITY STATE ZIP
PHONE NO.
I*e6:rr %Z63o
��/S� G69� 8�82
OFFICE USE ONLY ve '
PERMIT NO. v '�. ®'t • Q 10 1-0 A'Y_
PLAN CHECK NO.
POOL P/C FEE $ cook'
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls