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HomeMy WebLinkAboutS2021-0260 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION CITY OF NEWPORT BEACH J,. BUILDING DIVISION NT OR TYPE r ADDRESS (NOT MAILING ADDRESS) I �—o � �➢'P•H nZ LOT TRACT 2. DESCRIPTION OF WORK �->4 SSP U I ESTIMATED $ VALUATION �e ✓r n L��ic ofaco t�✓�I� SWIMMING POOL ❑ SPA POOL FENCING ❑ DRAINAGE Check Appropriate box for Appl m (,\MC`K✓Scv— t- ro \ N P *�t 7>�,7— tj-,?6 C- — LAST FIRST LICENSE NO. IGINEER'S NAME n^ CGC)� '� (+ H^ �J S n ✓� V v ^^ ` conn ennRFFS l2 G r �1n S C 1 ✓� ZIP PHONE NO. CITY STATE �i 3v C b - 611 ►°r c l of icmIPRR I (CENSE STATE LICEN' ,: c-1 �6o U5 3?7 �cv STATE ZIP PHONE NO. CITY p� O1,ZZ CIK� ` 0�`'�g �13 IF� ev1 FFICE USE ONLY C` a m 0 PERMIT NO. J Zs v1 PLAN CHECK NO. y�� o POOL P/C FEE $ DRAINAGE P/C FEE $ Forms\Pool spa appl (rev3-04).xls