HomeMy WebLinkAboutS2021-0252 - Permit Applicationi
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PLEASE PRINT OR TYPE
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH 921DZI-0252,
BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK 9E(,AJ 't'60Z- 7'3 1 '5- ``) 7cA!SC'1% jScor,?
i` IOGS A-), L C UL C s ( ESTIMATED $ VALUATION _' 1r 10�
SWIMMING POOL [c]— SPA B POOL FENCING ❑ DRAINAGE
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
OFFICE
ADDRESS
OWNER'S E-MAIL ADDRESS
c� �GY—fs��n��
CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
t Z C- i �,J - ZkSir vi AV �
STATE ZIP
l�� V �` VtA c A— Tz- s(
AV,,
ONE NO.
6—)D —611,4
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5. CONTRACTOR'S NAME
R-C / �j
BUSINESS LICENSE
STATE LICENSE ?
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No. f O (9 y`l Class�J
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
(� r�
31 c v-('✓✓ y ✓ T
CITY STATE ZIP
PHONE NO.
A-
Cj o CA--
OFFICE USE ONLY f r
PERMIT NO. 7�/ �J21 O�2 �� •r�DrJ�� YilAZ�' 01��
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls