HomeMy WebLinkAboutS2022-0024 - Permit ApplicationS2o2(z-oozq
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
J d��Om
U': n
CITY OF NEWPORT BEACH
` BUILDING DIVISION
McmH =
"I. I'KUJtU I AUUKt55 (NOT MAILING ADDRESS)
263 C--) W4100 sTINeWfWRteH rCA 924-�60
LOT
BLOCK
TRACT
2. DESCRIPTION OF WORK_ NtUj 'i1piA 4 2_6 �;Bi .F7,
ESTIMATED $ VALUATION 086
SWIMMING POOL ❑ SPA POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
K4 S'7"Nt-rZ fC LG�'�
ADDRESS
2G 3c SAJ;0 •u u P 7
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
kfuvl3c i CA fZ �O
f 4l ,o1 -;r62
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
� Ufi2�q. '�aNl
5. CONTRACTOR'S NAME ����^ 1 Lp� �1 �I
I QI,�VS7/� "�Of�f�vcu ll�i l.. of/"I'�Qu fd%
B�iUSSI7NESS LICENSE
L719�v '7 66,1No.o�UY
STATE /LICENSE
Class
ADDRESS
.49 o 1� upf T gLtr'>7 ; s 5"v
CONTRACTOR'S E-MAIL ADDRESS
V [ M" -Db t mom .
CITY STATE ZIPPHONE
O.
CDVA A gz�
921f34't7. TP
;E USE ONLY
PERMIT NO. S2D 2-7
PLAN CHECK NO. ® � (�2 0, 7,0,2,2/
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa app] (rev3-04).xls