HomeMy WebLinkAboutS2021-0046 - Permit Applicationfv
52021— 004 to
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
I %( 6 }lit C, j/ t�
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATION fid 100 C'
SWIMMING POOL SPA `p` POOL FENCING ❑ DRAINAGE]
Check Anaroariate box for Aoolicant
3. OWNER'S NAME
LAST
FIRST
V,I vac ( )f L)6(61
l(� ADDRDSSOWNER'S
E-MAIL ADDRESS
'7')b N �i4M ,tib
CITY
STATE
ZIP
PHONE NO.
b"
C (A17/y(,p
/�
I-,
(,,(qSSZ f �S qo
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
peon ab,ylt
r'l oo c) i
ADDRESS
ENGINEER'S E-MAIL ADDRESS
�'?-D9 N ..lobvi
CITY
STATE
ZIP
PHONE NO.
(��
0)�c
7114
5. CONTRACTOR'S NAME
w�
BUSINESS LICENSE
STATTELICEN
7 qda Oitll
No.�06VO llask
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
cad
C
tic
ZIP
PHONE NO.
(�ST�AITE � 7
l"ir/v O Y' �
7 q
—I) f
OFFICE USE ONLY wry
� _
PERMIT NO. i
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls