HomeMy WebLinkAboutXR2024-0909 - Permit ApplicationWORKSHEET 1`01 6 C COM' MBINgTION kRMIT APPLICATION
i
I'.t � I`.
CITY OF NEWPORT BEACH
A BUILDING DIVISION e��1
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
(f) _CIFIc-
LEGAL DESCRIPTION
LOT BLOCK
TRACT
2. DESCRIPTION OF WORIt� ��jOT TU13 ESE CT RfegL ff� 6�
ESTIMATED $ VALUATION 4. (500
SWIMMING POOL ❑
SPA 44 POOL FENCING ❑
Check Appropriate box for Applicant
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
KATR Ele )NE /aN 4 'w/ALL4C-
ADDRESS
OWNER'S E-MAIL ADDRESS
2301 PAC1 H' DR
`A0j"� ,MA)L.
CITY STATE ZIP
CO NA DFt NA CA
PHONE NO.
,4-5450-33L-0
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE STATE LICENSE
P. CO N S rR u c i i V N
6 No. rC it
ADDRESS
t�@ class
CONTRACTOR'S E-MAIL ADDRESS
2 3 O52 A Ll c i A phviY ,,y l46o e,
v1 PC-o I (OL &t( A i L Co M
CITY STATE ZIP
015SIoN /IL-S6 cA �r9 2
PHONE NO.
q4`1-4"_20
OFFICE USE ONLY
PERMIT NO. 0 pg09
PLAN CHECK NO.O'i1'Zj
POOL P/C FEE $
a
'55
DRAINAGE P/C FEE $