HomeMy WebLinkAboutS2021-0219 - Permit Application (2)WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
5 own ' h
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK VW0I I yX
SWIMMING POOL SPA
Check Amrooriate box for Annlicant
�wf -5 314)
ESTIMATED $ M
POOL FENCING ❑
--0--_—
DRAINAGE ❑
3. OWNER'S NAME
LAST
FIRST
15c6ar
&fm `.
ADDRESS
OWNER'S E-MAILADDR SS
5/ or
vrr dei
CITY
STATE
ZIP
PHONE NO.
2w rk
ach C"
72660
0//778 72f �5
® 4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
b h
%Ise r
o
ADDRESS
ENGIN ER'S E-MAIL ADDRESS
Z01 N jus A
Aw
CITY
STATE
ZIP PHONE NO.
�na1'ei�n
C/�
9zSo7 7/y W-6lva
�5. CONT OR'S NAME
BUSINESS LICENSE STATE L�ICnENSE
`
U
No. 618W Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
lD 0- `f� 5 -1 -
CITY
STATE
ZIP
PHONE NO.
�an n.,
2.701
7/y 3?3 -6'35
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO. �� 2 l 3 �f D %/ uc
k ail
POOL P!C FEE $
DRAINAGE P/C FEE $
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