HomeMy WebLinkAboutS2022-0057 - Permit Application (2)<SWPO
o� WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
...• CITY OF NEWPORT BEACH 5202? --G n—
BUILDING DIVISION s
PLEASE PRINT OR TYPE
(NOT MAILING ADDRESS)
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LEGAL DESCRIPTION AP -N • 04q—�t• .L ri
LOT a60 BLOCK '17 TRACT
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATION
SWIMMING POOL NL SPA N, POOL FENCING ❑
Check Aaarooriate box for Aaalicant
3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
14P20 IGtN S RD
RSO -T"�4 10 akoo.co
CITY STATE ZIP
PHONE NO.
N5 CA qvq<005
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
IZoi to ? s;014 40.
ckxist>e LNDokno.eon-1
CITY STATE ZIPP
HONE NO.
ANA G,tq CA- 907
'ilii 00441
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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TS(Zor T�VULS
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
5afa.h ih (dA
ggzl c,E S
ri L@ m&� CO
CITY STATE ZI
HONE NO.
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:E USE ONLY �!�1 fM - y� ' J "' K"� • L{aB'.
PERMIT NO.
PLAN CHECK NO. 1 JV/1�(/ • yVl�f�
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls