HomeMy WebLinkAboutS2021-0212 - Permit ApplicationPLEASE PRINT OR TYPE
CITY OF NEWPORT BEACH
BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
/o o /Lombro 2 L
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Add 6 eki-Aq a6o/ odd cgy"
(/At y w all -f a Cfa/r pr o f b o h of —b eeg w,, ESTIMATED $ VALUATION
SWIMMING POOL [l SPA L� POOL FENCING ❑ DRAINAGE ❑
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3. OWNER'S NAME
LAST
FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
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CA
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9Y -,z/Z -F4 0 /
4. ENGINEER'S NAME
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LAST
4c
FIRST
C4r/S4�-r/'
LICENSE NO.
7y103
ADDRESS
ENGINEER'S E-MAIL ADDRESS
/Z a / u VQ—
CITY
STATE
ZIP
PHONE NO.
14174 `t-e/.V7
piq
9Z (F0 7
71y- (03 A - (0/ft o
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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ADDRESS
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CONTRACTOR'S E-MAIL ADDRESS /
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CITY
STATE
ZIP
PHONE NO.
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1 71Y-YZ o -r 73
'E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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Forms\Pool spa appl (rev3.04).xls v — 05
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