HomeMy WebLinkAboutX2022-1696 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICA IONS
CITY OF NEWPORT BEACH ,,Q�Il JN.
v� BUILDING DIVISION,
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
`7L4 UA)bA IS ,/0F3! CA 9 Z " 0
LEGAL DESCRIPTION
LOT '7 q BLOCK TRACT
2. DESCRIPTION OF WORK 06^ST(2UGT 7bc)/, V',SP64 Lo/Ck A-)
0��� ESTIMATED $ VALUATION (r O
SWIMMING POOL SPAR 0tFENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
IJ A /cS1
CITIY STATE ZIP
PHONE NO.
Nle) C-4 9Z�,(p6
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
AP c m6 N,�--2l ky-y- ,rho �o t�Z i � J-; I eE7
C(o q 7(!�i
ADDRESS
ENGINEER'S E-MAIL ADDRESS
J400
I b (a pfq1 q ee r, co to
CITY STATE ZIP I
ONE NO.
PL A-G�&)T-/ 4 � ze 7 a
r1q of G(,i • ! 2-
5. CCP ONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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lNo.'?,z-,fi?� Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
'z 7C�yahoo,
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CITYY/ STATE ZIP
PHONE NO.
Ole A) F C, 4" '7z23 ,
OFFICE USE ONLY
PERMIT NO.
1
PLAN CHECK NO.
POOL P/C FEE $
kGE P/C FEE $ q,
.ms\Pool spa appl (rev3-04).xls