HomeMy WebLinkAboutS2021-0270 - Permit Application/ NF.\YPepR
tea o
a
f n
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS p
G -37, L.,
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH 14
(Z
}� BUILDING DIVISION rCsU7 tiAi
I LOT BLOCK TRACT
2. DESCRIPTION OF
SWIMMING POOL 2-' SPA
Check Appropriate box for Applicant
ESTIMATED $ VALUATION 5 CLCDO 'D
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
ADDRESSOWNER'S
E-MAIL ADDRESS
z g L_!�I pp(�
CITY STATE ZIP
PHONE NO.
'mcw PoLz < -m(t--
C 9Y9) bSc1---7.
17 4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
,:AQA OD
BUSINESS LICENSE
STATE LICENSE
Nollb-7�< Clas�
ADDRESS g�� _ _ ' n
T
CONTRACTOR'S E-MAIL ADDRESS
36M'D Fo�' '61 vat 1 t4-`iLVre• � Z�
CITY STATE ZIPPHONE
NO.
jvx6 'moo w
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
C)Z%