HomeMy WebLinkAboutS2021-0022 - Permit Application"ew0 aT WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
>` 7 "mr CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LOT —.,"....,.l� 1 1.,14
BLOCK „ /� „ TRACT f
2. DESCRIPTION OF WOVK m vn )I&
e o I cr✓ i
SWIMMING POOL SPA 1
Check ADnrooriate box for Annlirant
1� ESTIMATED $ VALUATION
POOL FENCING ❑
DRAINAGE Ll�
3. OWNER'S NAME LAST FIRST
,, ji
ADDRESS
OWNER'S E-MAIL ADDRESS
W 0 J'c cd c 1 Z& ,nC%J . C c PA —
CITY v STATE ZIP
Corona 00 Ka-r
PHONE NO.
�7'y)3YK-7B76
4. ENGINES- S NAME -- LAST /�I Ls EIRST�
Co Mj
�,� 2 �J ��G(i ��(-�i�
LICENSE NO.
/�
!� t 5 ! li /E F'� 11 (,- l.�
r ' d /uc/n< jr�eriirr
lne / ����
ADDRESS
/ Z-0 /1 h tie
ENGINES 'S E-MAIL DRESS
Cep
, M
CITY STATE ZIP
A&cl�-- %ZY07
IPHONE NO.
7/0, 30--6/0o
5. ONTRACTOR'Sy�NAME
14 i00�
BUSINESS LICENSE
STATE LICENSE
J4�fI� /L
No.lo5b`73� Class
�//ADDRESS nn,�
Jb�l VIA /ttiaytlTUe �
CONTRACTOR'S E-MAIL ADDRESS
Sci�li�oesccvgr25z e 'com
CITY STATE ZIP
6ueV\a- rar`� CA— q0(Z/
P ONE NO.
l(710q'(3-4763c)
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
5202-1
- 00 't,
n 2oZ1 —ol u�
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls