HomeMy WebLinkAboutS2021-0051 - Permit Application(f)
PLEASE PRINT OR TYPE
LOT
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
(NOT MAILING ADDRESS)
2. DESCRIPTION OF WORK
:3110I9i:1
S?02-1 - 00SI
5-IJ3 SayV �,�✓IMr I/7()
TRACT
I
ESTIMATED $ VALUATION �b-5� , 000
SWIMMING POOL SPA POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME FIRST
nn B�LAST
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tge&Y ?JfoL P
ADDRESS
OWNER'S E-MAIL ADDRESS
E�� SGY �e��aKC9�n �i vee
,E)noc, x G l7C(1 v�. oor"
CITY STATE ZIP
PHONE NO.
Uew,�>o)4 6fa&/y) C�k R( LGO
(aq qt) 2aq- �/.�RC1
u 4. ENGINEER'S NAME LAST FIRST
LICENSELICENSE NO.
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ADDRESS
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ENGINEER'S E-MAIL ADDRESS
)4o6voo1e-r? .COrl
CITY STATE ZIP
PHONE NO.
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(71 �) (o w- 6101
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
3W' UCLVf((.L o
No. &67C('i Class$
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
15C�CaU f 00d fit.
5 0 5n(o- ad 60r,-?
CITY STATE UZIP
PIqONE NO.
C+7h�1{I� Co. qo&0,
5g22) 7� -2)qj
OFFICE USE ONLY S�Zi • �
PERMIT N0. q�
�5 W ',
PLAN CHECK NO. �
POOL PIC FEE $., \ 2,112-
DRAINAGE PIC FEE $
Forms\Pool spa appl (rev3-04).xls