HomeMy WebLinkAboutS2023-0146 - Permit Applicationw WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
gyp.' CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT /O BLOCK TRACT 70 5-
2. DESCRIPTION OF WORK C�wS( dZt
SWIMMING POOL v SPA ly,
Check Appropriate box for Applicant
ESTIMATED $ VALUATION
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S -MAIL ADDRESS
An
CITY STATE ZIP
PHONF, NO.
C7 (`Y
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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(D7(o�cU
ADDRESS
ENGINEER'S E-MAIL ADDRESS
12-Cil 1O,, TUST1 ti G,4—
4C'A6I U e--
CITY STATE ZIP
GP4 z-O,�7
JPHONZO.
V50 Cot L
CONTRACTOR'S NAME1
BUSINESS LICENSE STATE LICENSE
lNp.S'2,327,.—
Class
ADDRESS
NTRACTOR'S E-MAIL ADDRE
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DSice. Z7@ hcciccl; i
CITY STATE ZIP
PHONE N CiLr *,y f
17
02- )' -, E �; C-( f '
11 Z`
OFFICE USE ONLY
PERMIT NO.
�I Plh
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls