HomeMy WebLinkAboutS2021-0006 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
V
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
lk 10-7 14(,ciAAckvJ nv
LOT
2. DESCRIPTION OF WORK
BLOCK
SWIMMING POOL [ SPA
Check Aooroorlate box for Annlicani
TRACT 30
ESTIMATED $ VALUATION OO
POOL FENCING ❑ DRAINAGE
3. OWNER'S NAME
LAST
FIRST
H ewe s
ADDRESS
1 I M
OWNER'S E-MAIL ADDRESS
n c
CITY
STATE
ZIP
PHONE NO.
e O(� C ro
C (li CI 9-G Co C)
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER' -MAIL ADDRESS
CITY
STATE
ZIP PHONE NO..
5. CONTRALTO 'S NAME
�
1(�,L
BUSINESS LICENSE SAE LICE
C
�-�ySr--F,T-rid No�j Class
ADD
of 1�n�ev� CSL
CONTRACTORS E-MAIL ADDRESS
pm MAI�.Co
CITY
STATE
ZIP
PHONE NO.
os ,✓ U.
G(/�-
22& 27
:E USE ONLY
PERMIT NO. S?XV . ODDla
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa apps (red3.04).xls