HomeMy WebLinkAboutS2021-0045 - Permit Applicationr•'9a WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
\$
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
l9 6Rw;SE2S-t3L.ctiq
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK QP�4 •S f e� r" G L Gh d 1,/4 -
SWIMMING POOL 9
Check Appropriate box for Applicant
ESTIMATED $ VALUATION f QG cJ
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
f/-�:t9L(�
ADDRESS
OWNER'S E-MAIL ADDRESS
r r
S' �iz� ° S 2f �3� Ll ry-`I
#4- i ',/o J/7"!4L.
CITY STATE ZIP
PHONE NO.
/v;whaVf �Z�'i?
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4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAM/EI
BUSINESS LICENSE
STATE LICENSE
14`144/AM, 0���
-"'//cClass S�
I N
No
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIPPHONE
NO.
(51�zAn 04 ���6.
Z68'3s'3-•io�Z
OFFICE USE ONLY
PERMIT NO.
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to 2-1
/�/� J
– lJU 's—
PLAN CHECK NO.
VcJ�
(9 Oct
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls