HomeMy WebLinkAboutS2022-0023 - Permit ApplicationNp_w'r��R WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
BUILDING DIVISION
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1. PROJECT ADDRESS (NOT MAILING ADDRESS)
IS -50 �rci Ski✓11�� (2L
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK_`POC)L�2�q"7� 13 (w -+ 36/ 0�15co srl1lwc`�
61'47 1� T
Q Cllt C v \J :Q �V"- ESTIMATED $ VALUATION �S(oOC�
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SWIMMING POOL [U SPA E POOL FENCING ❑ DRAINAGE E9�
Check Aaarouriate box for Annlicant
3. OWNER'S NAME
LAST
FIRST
ADDRESS
( "J6 "pc) i k vl
OWNER'S E-MAIL AD DRESS
CITY
N P r3
STATE
C ►°r
ZIP
611-66- a
PHONE NO.
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4. ENGINEER'S NAME
� LAST
L• C lf�
FIRST
✓
LICENSENO.
CU N CU N
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ADDRESS /gyp
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C -
ENGINEER'S E-MAIL ADDRESS
CITY
( �rA o vv
STATE
C
ZIP
1 -t
IPHONE NO.
A 610 - 6w-1
CT-/OR'S NAME y
5. COONNT^RAe-5-1
BUSINESS LICENSE/ e�
STATE LICENSE
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No. i��VN elass�3
ADDRESSCONTRACTOR'S
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E-MAIL ADDRESS
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CITY
W13
STATE
Cid—
ZIP
9-Z663
PHONE NO.
CIA')
CE USE ONLY
PERMIT NO. '�Z-Otj • pq« �atl2ZX2_3
PLAN CHECK NO. D I(0
POOL P/C FEE $
DRAINAGE P/C FEE $
Foons\Pool spa appl (rev3-04).xls
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