HomeMy WebLinkAboutS2022-0193 - Permit ApplicationF� H
Y \',
PLEASE PRINT OR TYPE
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION $ �oa-a- CM 3
CITY OF NEWPORT BEACH
BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
92( Al8e,r Pl,,ce , I CUJIDC)4 CA
LEGAL DESCRIPTION
LOT tZ BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING
Check Appropriate box for Applicant
ESTIMATED $VALLUATION !;-C), OOo
—
POOL FENCING I� DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
Jow
ADDRESS t AiII&f �-00? L
OWNER'S E-MAIL ADDRESS
CITY 0105 STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
10�600'
LICENSE NO.
al 6:9P
ADDRESS ( {
ENGINEER'S E-MAIL ADDRESS
CITY p}e d� STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
(,ec�Gt� CUs}cvh He�25 1
L3�a�'2 IZ�21)
BUSINESS LICENSE
ai300�rSO�L-
STATE LICENSE
No.���ly4 Class
ADDRESS I0C'O QJq� rPfl
CONTRACTOR'S E-MAIL ADDRESS
blakeglt,Tc�110.' escx. wv✓1
CITY Ne�Po> Q�c l STATE LA ZIP -�? C�
PHONE NO.
`14.9 S3 ,7 6 23Z
;E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
OV &
DRAINAGE P/C FEE $
FormsVPool spa appl (rev3-04).xls