HomeMy WebLinkAboutS2021-0152 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION 1
CITY OF NEWPORT BEACH
PLEASE PRINT OR TYPE BUILDING DIVISION
A
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
05,02gI &U44-ID S�
LEGAL DESCRIPTION
LOT 149 BLOCK `� 51 TRACT IS 000 ?A-yview
2. DE CRIPTI N OF WORK CONSreZ UC``r t')OL4- SPQ r7AS "jb F ga-PI -r
r
YAI , e- ESTIMATED$ VALUATION
SWIM ING POOL/K SPPK POOL FENCING ❑ DRAINAGEX
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
M i c e s-Ta t2--
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
M C14 q 2 (oU 0
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❑ 4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
Isoi N . -US-n tJ
Tapb L- pnZe-ErJ61 A3EM4
CITY STATE ZIP
PHONE NO. C
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I "f (0311
❑ 5. CONTRACTOR'S NAME
B 1Ll�SINESS LIC NSE
STATE LICENSE
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
! (P 39- AL604(kv I" ST' 4 3 12)
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CITY STATE ZIP
PHONE NO.
4-Its C4 ar2jvLlgi
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OFFICE USE ONLY ���' ^� 0 l^ '
PERMIT NO. J Zc l-- C L"/ �' `,JI
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls