HomeMy WebLinkAboutS2021-0058 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS) q /YJ�- ( 0 r 1 ^
III\
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK �( ✓V )1: I 5-
SP).X— 0ti58
W61 t oAl tj&to
4r6Q (04 ESTIMATED$ VALUATION
SWIMMING POOL SPA POOL FENCING ❑ DRAINAGE ❑
Check ADDrODriate box for ADDlicant
3. OWNER'S NAME LAST FIRST J
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
Cvcovw PeA M_oy- M 1)-_b� 5
PHONE NO.
4. ENGINEER'S NAME LAST 49 1 it v, ba6� I- r1 �
LICENSEI qOD-3
[ADDRESS ``rr („IJ� �(-�
L�' w T�', In Act
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
�- �(Z�o
PHONE NO.
(7iq)61_ 69 ne
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
lNo-_775'011
Clas��
ADDRESS lIti —1 g 4D
CONTRACTOR'S E-MAIL ADDRESS
STATE ZIP
GJil��o��� (� q_25-qS
PHONE NO.
�g57�Z32-5S9�d
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Jul.I. D058 X 0?,( •Q�g�
(�Oal0fi*
`D201q.42. J
Fom MPool spa appl (rev3-04).)ds