HomeMy WebLinkAboutS2023-0076 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
rLtAbr F'KIN I UK I YYt
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
3ge6 R w--r >
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL ❑ SPA L
Check Appropriate box for Applicant
a.e C ti
ESTIMATED $ VALUATION 6t GOO
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME r AST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS -
CITY STATE ZIP
PHONE NO.
5. IIC__ONTRACTOR'SS�NAME
� on4e-r ''av1 (S�ns { rvcE u✓�
BUSINESS LICENSE
STATE LICENSE
No. QS9'o?3 Class
ADDRESS
5�Y 35�' & — Uni d
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
fie—pora- ser"t, ek ga663
PHONE NO.
P6-1497-7909
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
S2a2--s- oo? G
PCZ&Z 3-0/g5,6