HomeMy WebLinkAboutS2021-0178 - Permit Applicationa
PLEASE PRINT OR TYPE
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH (�20�t1 _O'
BUILDING DIVISION c�
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK �ei��cJ
SWIMMING POOL [ V SPA ❑
Check Appropriate box for Applicant
ESTIMATED $ VALUATION (0, d 0 U
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME FIR T
p BLAST
ADDRESS
OWNER'S E-MAIL ADDRESS
11
r
t7
CITY STATE ZIP
X/,tp 6/8�- V z64o
PHONE NO.
�` - az o - D2 oZ
4. ENGINEER'S NAME LAST FIRST.
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE 777
HONE NO.
5. CONTRACTOR'S NAME
BUSINESS
BUSINESS LICENSE
STATE LICENSE
/
/�— 4AI S "l �����
c�//ry6 C-53
t V
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
227 I/�/. C-/•{{�-('L ��i ' /"+(''K
0,5 �_ �u t� /d�,�) Si1y�'%4 /'�ChJ�. Lc
CITY STATE ZIP
PHONE NO.
n
aLl` -b/ C-/;- `iLCf,(?
Loi -33 3
Z USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).x15
175 Q - DMZ