HomeMy WebLinkAboutS2021-0108 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
2-10 i Z�V\
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK ,(3� (p fuel ---3 l�5t f
PZ ef"`"119 iow /��I ✓XUvh� �4cC ��� ESTIMATED $ VALUATION
SWIMMING POOL SPAW POOL FENCING ❑ DRAINAGE
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
ADDRESS
2
OWNER'S E-MAIL ADDRESS
-to?
An,ugol34lzese/3r�v�_.��v
CITY STATE ZIP
Pe "rte >�I
PHONE NO.
C14- 7 a
90-3gY-toloy
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
05. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
%n 9 6
4-L,4N Sn L e3� �gd�S
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATEZIP
0 �- I ;
PHONE NO.
�8-3�- -/ �
'E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Farms\Pool spa appl (rev3-04).xls