HomeMy WebLinkAboutS2021-0211 - Permit ApplicationS2o2( - 02► I
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT
n/ADDRESS (NOT
�MAILING
'ADDRESS)
Ir �VV -_
LEGAL DESCRIPTION Q,,�
LOT BLOCK II �44+
� TRACT �j08'L
2. DESCRIPTION OF WORK C joPOT 1 F W 1 WV4 tvWl! jt � � V
IN � IQr ESTIMATED $ VALUA
SWIMMING POOL`X SPA ❑ POOL FENCING x �RAINAGE ❑
Check Aooroariate box for Aoolicant
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S AIL ADDRREESS
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lim
lMlp-t"l.
CITY STATE ZIP
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PHONENO.So
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4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
lotyl,00p ov
ADDRESS
NGINEER'S EAIAIL ADDRESS
1101 N. � !N A
vewl . Go
CITY STATE ZIP PHONE NO.
ol�/u
"rw0040
6A 12&07 ll+,
5. CONTRACTOR'SNAME
BUSINESS ICENSE
STATE LICENSE
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No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
:E USE ONLY
PERMIT NO.
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PLAN CHECK NO. -� n � 7 v �
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
2lou?- D2
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