HomeMy WebLinkAboutS2021-0074 - Permit ApplicationS2,0zl —UU-7`-�
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH3U �U���� ��
BUILDING DIVISION
rLMA*r MIN 1 UK 1 YPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
63o RAAlPA/4 D�'/YE r's,QonrA AF4 44AX 92625
LEGAL DESCRIPTION
LOT BLOCK
2. DESCRIPTION OF
SWIMMING POOL ❑ SPA [�
Check Appropriate box for Aonlicant
_ ESTIMATED $ V)
POOL FENCING ❑
..
IR
DRAINAGE k
3. OWNER'S NAME LAST FIRST
✓erNIc ,A"r //,Vl
.
ADDRESS
OWNER'S E-MAIL ADDRESS
G3® /1A-'vlox-A �'J,NirP
✓eh/vZ-viv&7P6AZa c-0epi
CITY STATE ZIP
PN
rvA',PA,A D.pt— /V!,4,W rA. 92625
9izEN 01,0-5164
04. ENGINEER'S NAME LAST FIRST
LICENSE NO.
BrE�E�vB� coyc'H/1/TTaoyE.�
7 VDJOY
ADDRESS
ENGINEER'S E-MAIL ADDRESS
!ZD / N. 97v1' r! n/ A ve
�y,Q/,rTOo�E�� P ?AP4 4P.4.7. c -v
CITY STATE ZIP
PHON NO.
A,vX �V el4I (-A C/-
(9/y &3o- 4,) 00
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
3"C it WAoe AnDc.s
j�o79ZS C -S3
NO. Class
ADDRESS '
CONTRACTOR'S E-MAIL ADDRESS
P.v. AX 2���7
�r»!vl P r-cA+vq✓� Dalt, ra/Y!
CITY STATE ZIP
J,, ^1-rA AW -4 CA 92 799
PHON N
y/V)2411_ 7b�s
CE USE ONLY
PERMIT NO./�
PLAN CHECK NO. O Ov
lop AI
POOL P/C FEE $ If/
DRAINAGE P/C FEE $
rormsirool spa apps (reV3-U4).xls