HomeMy WebLinkAboutS2022-0247 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
1-13Q, 0mvIcA1eSttcK- (-N
t4N Ci- A- • 01
LEGAL DESCRIPTION
LOT BLOCK TRACT
2.DESCRIPTION OFWORK -MGisfer Fml cind tpcd . Uce drUio c vel
(AVIA a Ar-YI Fii*i N1 - ESTIMATED $ VALUATION V I E200I3-• (t�)
SWIMMING POOL Z- SPA 0 POOL FENCING ❑
Check Appropriate box for Applicant
DRAINAGE ❑
3.
OWNER'SNAME
LAST CC4IIiSW[-
FIRST 7C)M
ADDRESS t1 3-3
CcA v A I e s- L 1=
LN
OWNER'S E-MAIL ADDRESS
t"0 v✓I • MCcf I I r s t� r@ cb r� G6 rr�
7y Newerrt
BnGch
STATE CA
ZIP
PHONE NO.
Of269Co
cq jq) (2-is-Is4v
4.
ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5.
CONTRACTOR'S NAME (^V) SMj-"4
PGbIS
BUSINESS LICENSE
STATE LICENSE GS3
Cto t
No.,j- �.,�110 ClassC�St
ADDRESS ZZ�I
,�A� {{
V V �rI e tOh
Ave
CONTRACTOR'S E-MAIL ADDRESS
(Avje1.1qeZp q),�t✓I swrthyools- cowl
CITY om yiqP
STATE C,4
ZIP
PHONE NO.
C-1 19) n2— (0-1 bZ
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
520222- 02 41
PC�Z02-?-- 2-q6� 5
DRAINAGE P/C FEE $
FormslPool spa appl (rev3-04).xls