HomeMy WebLinkAboutS2022-0094 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
> 2 iAS"A-�AJ SE-A,MEL0P<0e-T co4S T, c-A-
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORKOO&�,-7' FtCy Vt-<S-�A 45,6+0 . 7ycT7J/t�
ESTIMATED $ VALUATION (, SS ? 00
SWIMMING POOL ilk SPA POOL FENCING ❑ DRAINAGE
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
I 2, % �S/�!� SEA-
rro C-h-f-q o 17VY- V 3ca rncU � co
CITY STATE ZIP
P ONE O.
&OWP607i ca C5 CA 92.G5
2(02-339_
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
c®.),s-r . ?eDart- /o 4)AVIb
c s 31 �. -7
ADDRESS
ENGINEER'S E-MAIL ADDRESS
/1�40 GO �IqS SANS ]�Q, zr�Z
daV-eQcoaj�-Sha12e.ca1-1
CITY STATE ZIP
PHONE NO.
<-�1 (7217) S
I L3S8. 720 . l o o
5. CONTRACTOR'S NAME Q/4L)E io&1J70N
BUSINESS LICENSE
STATE LICENSE
1LU/D d n)�1,M(CS /��OOLd�P¢
lNo.go,??S-qClass
ADDRESS CONTRACTOR'S E-MAIL ADDR SQ-r-441, / jz�
(02o C- Cv4 [,v U7' S% ciq vie@�d oo/.C�,y —`r/
CITY STATE ZIP PHONE NO.
FLO) t7,�A) G,4r
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK VI�q- `z
NO.
POOL P/C FEE $�:(f
DRAINAGE P/C FEE $ � ✓C�-- -�
Forms\Pool spa appl (rev3-04).xls