HomeMy WebLinkAboutS2023-0185 - Permit ApplicationrewP°°> WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
Ue� CITY OF NEWPORT BEACH
G IIO0.0.„
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
2O PeZ
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL ❑
Check Appropriate box for ADDlicant
ESTIMATED $ VALUATION
POOL FENCING ❑
DRAINAGE X
3. OWNER'S NAME LAST FIRST
e,1416
ADDRESS
OWNER'S E-MAIL ADDRESS
V �� 7J`
C''e. �-CAl? 6oacmV,
CITY STATE ZIP
PHONE NO.
C ��e4-
7/-� 22Z_ 3
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDR
CITY TATE ZIP
NO.
r
5. CONTRACTOR'S/NAME
BUSINESS LICENSE
STATE LICENSE
/�
✓ L i� /G/ e--
No.79 3/3 Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
/ 3 22
aAl4 P.,,�46 "t'lel
CITY STATE ZIP
PHOfqE NO.
e�g U70s
M6 zz - 7385
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
52023. 0185
'PGZOZ's • 21 42
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls