HomeMy WebLinkAboutS2022-0256 - Permit ApplicationY "rs WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
rLCHJC rKINI UK ITYC
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
(a i VVH lA)(1A L�-)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL ❑ SPA Y _
Check Amrooriate box for Annlicant
_ ESTIMATED $ VALUATIOW (�:2 ,
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME
LAA�ST
pp
�FIRST
ADDRESS
NER'S E-MAIL ADDRESS
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7oc-yNr\-es-c6be-rCa
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CITY
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STATE
C1q
ZIP
Ae � ID
PHONE NO.
q- 76219,
rl 4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5. CONTRACTOR'S NAMEKI Le.
BUSINESS LICENSE
STATE LICENSE
6L
�
1 C7 ci% ��
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
Z 2 -7 5 . C� rci �
"e
vi w 0 , ae ,K- . w vY1
CITY
STATE
C
ZIP
PHONE NO.
:E USE ONLY
PERMIT NO. S z d 0 Z
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
I-o"sWool spa appl (rev3-04).xls