HomeMy WebLinkAboutX2021-0571 - Permit Applicationb
ot�e"p R @ WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH r
rx
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOTIMMrING ADDRESS)
q.'D V14- LIDO
LOT BLOCK
2. DESCRIPTION OF WORK I N�/IU[Se� ="�� Si Z.4
Cj LI ov L &0 r NOV (L ESTIMATED $ VALUATION 2361 `mo w
S SPA
Check Aoorooriate box for Applicant
3. -OWNER' S E LAST FIRST
ADDRESS
3a V/ L Ids e�D
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
P�j eq- ve4c,C 9 2_&�,3
PHONE NO.
Vol 07-//i
4. ENGINEER5 NAME LAST FIRST
LICENSE NO.
ADDRESS
ENrEE&MIWLXDDRESS
CITY STATE ZIP
PH NEN .
r oso�/
5. CONT CTOR'S AME
BUSINESS LICENSE
TATE L((IIfC''%E��NSEE
3
0 Chi -)(...5
N0. /2Lw Class
AD SS
CONTRACTOR'S E-MAIL ADDRESS
Cl STATE ZIP
�2 Z
PHONE N0.
ty"(7/1 #7� 7�3.3
;E USE ONLY 0^ �#,m
PERMIT NO. coq- 1
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Fortes\Pool spa appl (rev3-04).xls