HomeMy WebLinkAboutS2021-0099 - Permit Application'o. WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
Zo'l vii. G-eooc,
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK t-OCO C C AA o
t'rn0 .517 yl- 61 c6r
ESTIMATED $ VALUATION 9 Sc 600
SWIMMING POOL ❑ SPA t5-' POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for ADDlicant
3. OWNER'S ^NAME LAST FIRST
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ADDRESS
7-d
OWNER'S E-MAIL ADDRESS
\%(c-, �16cc
CITY STATE ZIP
PHONE NO.
9j f C3 CA--
-94�0k
4. ENGINEER'S NAME LL�ASST� FIRST
LICENSE NO.
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C.JI'�d� 1
ADDRESS
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ENGINEER'S E-MAIL ADDRESS
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CITY STATE ZIP
jn*!>A-Q,kcic�— C(7-
PHONE NO.
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5. CONTRACTOR'SNAME
BUSINESS LICENSE
STATELICENSE
Tu` T 5
53�l ii �} 1
No. wEL61 Ias5-3
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
•'"
CITY STATE ZIP IPHONE
NO.
CE USE ONLY
PERMIT NO. r
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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