HomeMy WebLinkAboutS2021-0071 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION S(J DOVO�VIv,
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
(S�6 C1>0izC7-TI-1� L r�
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Ql�W '?WL- F>2 r (S
Vt io U c ' ( t Pb� PM o Pormo rw tvi ATED $ VALUATION
/ por-c Ar tbremvr�>
SWIMMING POOL Ley SPA 0� POOL FENCING ❑ DRAINAGE r9�
Check Appropriate box for Applicant
3. OWNER'S NAME LAT FIRST
p N C-1 L-
ADDRESS
OWNER'S E-MAIL ADDRESS
�6 I >orZOTvl-t L-P�4jE�
CITY STATE ZIP
PHONE NO.
�3"M, c}- q-z�fd
9,tc-t�
4. ENGINEER'S NAMELAST FIRST
,(IE�\etAcvtV,,6 C C�✓L$
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
C2c\ �y TV�S—C\✓1 �lfC—
CITY STATE ZIP
PHONE NO.
P\,�,64vA c A— 01 2
,4"1 3c>-&iA
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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A
No.1i�rG W w l Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
1*� Dv'- --t-+'
CITY STATE ZIPPPHONE
NO.
6 c j - Cf�6 3
(01, 6�t�
:E USE ONLY
PERMIT NO. r�,���
PLAN CHECK NO. aS `V 4
POOL P/C FEE $
DRAINAGE P/C FEE $ '
Forms\Pool spa appl (rev3-04).xls
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