HomeMy WebLinkAboutS2022-0153 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
BUILDING DIVISION
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1. PROJECT ADDRESS (NOT MAILING ADDRESS) L¢j42 �O ft"cm leioj" PL-
New�rct , Gn 012(Pc00
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK YWA&WV MI 610ot Cps IVISW I I % Vle(A) ?001 I WIR-FS , r"I to
�bo\ ctyd � (AnA FbD\ C oily (.1� \21IGCe JC W) ESTIMATED $ VALUATION �DS~I-00
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SWIMMING POOL' SPA ,21 POOL FENCING ❑ DRAINAGE ❑
Check Anoronriate box for Aoolicant
3. OWNER'SNAME LAST MomT FIRST Lac-ie
ADDRESS 1(:b42_ CC)C--1 C),Vlke-joo F�•,
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OWNER'S E-MAIL ADDRESS
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CITY vpWVOo -F QeOC" STATE CC4 ZIP
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PHONE NO.
�014�) �55— t2c®S
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME ftty) SVil'(-VV) T>OD\S
BUSINESS LICENSE
STATE LICENSE Wt
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ADDRESS VW carte r 1e too � e ,
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CONTRACTOR'S E-MAIL ADDRESS
Vllek • t0r-P t\aVI SWIjtO PoO\S • COMA
CITY D�a'�e STATE / „ ZIP
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1PHONENO.
C'l\4) (")rlo2
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
514321V ° 0ls)
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DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls