HomeMy WebLinkAboutS2021-0062 - Permit Application (2)PLEASE PRINT OR TYPE
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION ^
CITY OF NEWPORT BEACH S7.07-1 -00(02
BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
r° 10 M o ct-4 4
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK 7'-µO W- - f°1'A 2-1
1
ESTIMATED $ VALUATION `I Y GaD
SWIMMING POOL ❑ SPA ❑ POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
S f c-- Y--1 c—
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
Ale::t~l 1"L*v
9Jj 314-- (vI %
n 4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
120 ( t4to- T14 YTL N A c
CITY STATE ZIP
PHONE NO.
A -*4 M-tH K 1140-1
'f`!,�- ble-(.100
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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8r3ao7 3r�1
44 �tQO 3
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
Ls1
&c.a,A- 1*c.y c4- 9u
141 $415-1011
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
11 POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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