HomeMy WebLinkAboutS2021-0128 - Permit Applicationr
PLEASE PRINT OR TYPE
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION S 2 -02 -
CITY
-02 CITY OF NEWPORT BEACH
BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION Ili
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL ❑ SPA 4
Check Appropriate box for Applicant
_ ESTIMATED $ VALUATION
POOL FENCING ❑
DRAINAGE Pt
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
-`lve v\
C TY STATE 1 r ZIP
Q' 6-(-- �` d—�J�a]
PHONE NO.
4. ENGINEE 'S NAME LASr FIRST
� IN � v
(.. 0 a -VII( LtLo
LICENSE NO.
651
ADDRESS
l 10 . ; �. kve
ENGINEER'S E-MAIL ADDRESS
S u� tw %+ /f C, A
Ap CITY STATE/� ZIP
c` q c)-9 ® 1
PHONE NO.
ON-) 00 -ISI D 6
5 CONTRACTOR'S NAME
Uva c—r�C \ Vl cv--
BUSINESS LICENSE
STATE LICENSE
No l 17getl Class-
:' ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
0,6\ (kV\
CITY STATE ZIP
't&,-I(qyq)
PHONE NO.
07-4-g95
u
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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