HomeMy WebLinkAboutS2022-0130 - Permit Application9
PLEASE PRINT OR TYPE
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
ll3C� Sew+;�5a or-1✓r
LEGAL DESCRIPTION y c e (-7 Cj 3- O "7
LOT
=1
TRACT
2. DESCRIPTION OF WORK 191IL-0 �
ESTIMATED $ VALUATION V30 V
SWIMMING POOL ❑ SPA
Check ADDrODriate box for ADDlicant
POOL FENCING ❑ r DRAINAGE ❑
St?
3. OWNER'S NAME LAST FIRST
i?YA0&" A i) o re -
ADDRESS
OWNER'S E-MAIL ADDRESS
Jar,-�-,�Sa
/13 L> �r�
ec, Ae- i j,dr �,t- EJ frG,L - e 0 f
:
CITY STATE ZIP
PHONE NO.
'1n6 r /— f / -z,6l, C)
q v 9- 6 �
4. ENGINEER'S NAME I LAN- (/e u FIRST
�J-� 5
LICENSE NO.
5
Uv7i ✓evs4� c r, �a' 7
-/YS
ADDRESS
✓e l4lrz
NGIN AILADDRESS
rnllc2 ca ;. ni✓ua cl� ��7—
1-7
CITY STATE ZIP
PHONE NO.
- 1 �7-7o
5. COIN✓RACTAR�S UAME
BUSINESS LICENSE
STATE LICENSEcz7
c—
r7r �00 5-`3z0
No7S G'z30 Class 3
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
,7 -e-.
CITY STATE ZIP
PHONE NO.
1/577� 6.1
%ry -7Y 75i
;E USE ONLY / ' R ^ �} 13 0
PERMIT NO. J �J G G
PLAN CHECK NO. 1 18 1 Z027.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls h ZZz 1 O I, J