HomeMy WebLinkAboutS2022-0188 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
U� CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK AleW goo) .TPOA
viY�rigrd✓•c�/ �p f, y� %fP ESTIMATED $ VALUA
SWIMMING POOL Lh SPA [9� POOL FENCING ❑
Check Appropriate box for Aanlicant
� 7 —C7
DRAINAGE ❑
OWNER'S NAME 61Z.S L�CU?& rg/U FIRST T) rv� 4- CEJ L2/Zr� y
c
ADDRESS
OWNER'S E-MAIL ADDRESS
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JPrP.�► �i�i�u�r77A/C�IV�i9l�1.
CITY STATE zrp
PHONE NO.
Ale4css CA C?z
r9yg)9'ZZ- S7S
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
Aar Divy�.✓cPr„✓ �[ 4cNEX -etp]J
Co7(v50
ADDRESS
ENGINEER'S -MAIL ADDRESS
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Tb1>t7L @ /rdch 9 t o."
CITY STATE ZIP
PHONE 0.
AA1,4/,!le'l Al cA
C%/51� 63D- iP/Da
❑ 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
Jcy...AR� 119r�vcS
1747?Z5' c'
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
v. 8v>< Zy�37
T yc tiW�r des ro,H .
CITY STATE ZIP
P ONE NO.
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�`� y h, p72 -.0 v SD
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
-a.,A
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls