HomeMy WebLinkAboutS2021-0175 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION /
CITY OF NEWPORT BEACH
S2
BUILDING DIVISION 02l t
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
/23'-!
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORKEo%,14Gt //vu( 4kIta„) c✓�� T„S�c�( ;eck`„5 le�l�ww�J
i
ESTIMATED $ VALUATION 17 5,151-! • o o
SWIMMING POOL SPA ❑ POOL FENCING ❑ DRAINAGE ❑
Check Aoaronriate box for Annlicant
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
23 y S
CITY STATE ZIP
PHONE NO.
Co/b.A A-1 ✓
qq4-56c-I6C--7
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
Ala,S --nti
No.57114# Class L6 3
ADDRESS
CONTRACTORS E-MAIL ADDRESS
�Iti'(.(N'i(.GaC�alawt+ k+(/��ols•tmc.
22-p- C✓ ca✓wa^ Ave
CITY STATE ZIP
NO.
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TONE
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OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls