HomeMy WebLinkAboutS2021-0068 - Permit Application,t `" a m- WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
�•�,° CITY OF NEWPORT BEACyr , �\ S 2AV 00A
BUILDING DIVISION ��
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS) I
/6Z7 1401AIeRS DIS
LOT BLOCK TRACT
2. DESCRIPTION OF WORK C: W li'o CLL 7 &7- �00L- 7,-U/6j J I V C 4 C
1 Cj aAS + 1151 CT.� STUCCO F t? -e P l i C*AS) ESTIMATED $ VALUATION fd0, 000.
SWIMMING POOL SPA g POOL FENCING ❑ DRAINAGEK
Chock Annrnnriat[a hnY fnr Annlicant
3. OWNER'S NAME
LAST
FIRST
�P
laa
Ra8�t
ADDRESS
OWNER'S E-MAIL ADDRESS
162,7 MARLt� CARS
vR.
CITY
STATE
ZIP
PHONE NO.
NeWPo3L:% (BeAck{
CA
%2660
7/%6o6--7718
❑ 4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
12.01 N, TVST-tO
A0,
CITY
STATE
ZIP
PHONE NO.
,4 NAMeiM
64
9Z807
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
SItvL-,eSP,eiN S
/W/-5 Ani ifPA5.
IjVc-,
No.8Clasel
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
2.S6Z5 /412ALOST15
Rtc4&SlLvc-RjPF-Itic-9'000.S.coM
CITY
STATE
ZIP
PHONE NO.
Ls(�-vN-F A11jJCL I
CA
?2677
1 q49 2/8 -Ssz`f
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Farms\Pool spa appl (rev3-04).xls
D Sql , 1 n4
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