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HomeMy WebLinkAboutS2021-0047 - Permit ApplicationS203 - 0�Hl °Rr WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION CITY OF NEWPORT BEACH BUILDING DIVISION PLEASE PRINT OR TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) LEGAL DESCRIPTION LOT BLOCK TRACT 2. DESCRIPTION OF WORK ti t iNwy U) ��.� t -6 J (%fit �?I Ci ��� Io (.'1 ESTIMATED $ VALUATION c C"` �a SWIMMING POOL © SPA [111-- POOL FENCING ❑ DRAINAGE F41 �- Check ADDrooriate box for Annlicant 3. OWNER'S NA—M�E� LAST FIRST ADDRESS OWNER'S E-MAIL ADDRESS CITY STATE ZIP PHONE NO. 4. ENGINEER'S NAME LAST FIRST LICENSE NO. �A 'S ADDRESS ENGINEER'S E-MAIL ADDRESS ( -��1d� ( l V\ t4�c.. STATE ZIP PHONE NO. �(�CITY �n 2 \W f n CA `? -ppi , J/ 5. CONTRACTOR'S NA+MEE. BUSINESS LICEN,Sy STAT(E�LICENSE "l�� No.��.riJ�Gi��"lClassc-% ADDRESS CONTRACTOR'S E-MAIL ADDRESS CITY STATE ZIP PHONE NO. Cr'GtAcoc �1`j tr_yt fit Cdr C "LG"t ct�U,i:i t/ :E USE ONLY PERMIT NO. S 2,0 Z PLAN CHECK NO. b 'J% q POOL P/C FEE $ DRAINAGE P/C FEE $ Forms\Pool spa appl (rev3-04).xls