HomeMy WebLinkAboutS2022-0165 - Permit Application (2)WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
y3 we>s Or, e 6,6A 92660
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Ae�/o Sr C�t i/gt-j)[ d a%2o-� -7
ESTIMATED $ VALUATION �0Q
SWIMMING POOL SPA ❑ POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
❑ 3. OWNER'S NAME LAST FIRST
l atf"'
ADDRESS
1 `i q 3 Nei mo Or,
OWNER'S E-MAIL ADDRESS
6 r,'s
CITY STATE ZIP
,vw,e-& G� 9Z660
PHONE NO.
4. ENGINEER'S NAME }1 LAST FIRST
-
LICENSE NO. L
22:;��tV
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
ftlavi Sm �+v Pa)
BUSINESS LICENSE
STATE LICENSE CAI
511 l cl w
No. Clas
ADDRESS 22-7
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
ST�2Z�0/(o S
AGZoZZ- /,??5
Forms\Pool spa appl (rev3-04).xls