HomeMy WebLinkAboutS2021-0203 - Permit ApplicationLOT
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
(NOT MAILING ADDRESS)
52,o2►-oZo3
TRACT
2. DESCRIPTION OF WORK �iSTr//uC17 /11-¢lfou✓�C� ,i�jejCf� tC-
,jg4�t/ana��rtgjr/ v�l. �4C(y/Ti ant�C��r/poa�W,1EST[MATED$V/
SWIMMING POOL Q SPA POOL FENCING ❑
Check ADDroariate box for Aonlicant
5 f ( ae cl
50000
DRAINAGE ET
3. OWNER'S NAME LAST FIRST
Pent
ADDRESS
OWNER'S E-MAIL ADDRESS
/4 6 A/ Ar? e
?r/ne 0- buI(j .Gow.
CITY Q STATE ZIP
M
PHONE NO.
U,.I bd- 92-6 6 0
-7777
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
Lacher %wd/
67hs(o
ADDRESSENGINEER'S
E-MAIL ADDRESS
/2-0/ /v . ✓e—h-fo
@ 06G(en .C.6M
CITY STATE ZIP
4171?hei.' (702go7
PHONE NO.
1
A—
7/Y-0o-6/oo
5. CONTRACTOR'S NAME
JG7MCJ 0 'bonht (I Cr f( F
BUSINESS LICENSE
STATE LICENSE
INMO(777o
- sa"15-r3
% - 00$"'3! (� �
Celass
ADDRESS
/ 73 / Xws-� Sf /3
CONTRACTOR'S E-MAIL ADDRESS
j1jvjS 00"Il .0-*ln
,LSraa
Pools@S
CITY STATEZIP
%7t�nTi✓I �irv, P4c`j P/4 �Zby6
PHONE NO.
71y-yZ6-5-y73
OFF/CE USE ONLY
PERMIT NO.
11 (�� �1 �O
r
PLAN CHECK NO.
!"' Y ✓ v
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls