HomeMy WebLinkAboutS2023-0007 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PI FARE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS). 2StS• VIA Matt-tV0 I
NBwpof+ Decich / Ct+. '1I2lowo
LOT
BLOCK
TRACT
2. DESCRIPTION OF WORK fmloSyr m7 gaol sP ,aettf" li iAf And Sl-imvner, IvirofMll
udraiyi cove(s olm cypiq� • RC- If LbOJA6Iitie ESTIMATED $ VALUATION co., loI S o0
SWIMMING POOL N SPA M POOL FENCING ❑
ChPrk AnnrnnrintP hnx for Annlicant
DRAINAGE ❑
3. OWNER'S NAME LAST Mc q\1ran FIRST Liwdol
ADDRESS vlA MC ri nq
OWNER'S E-MAIL ADDRESS
bAs•-e+bats nwo Cia ycingp COsn
CITY NeOPOr+ C3eaCh STATE CIA. ZIP92*0
PHONE NO.
0")(P1V—
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME )%yj SW1jtVj 'PiOkS
BUSINESS LICENSE
STATE LICENSE cb3
No. 1j-71 tel(0 Class
�7 ,,` /^!, y- a
ADDRESS 221 VV , co �-v11 rive ,
CONTRACTOR'S E-MAIL ADDRESS
IXNif 110(l'Z�(��G1VIS3V111 �PL�D1S LCWI
CITY p�STATE CA. ZIP
PHONE NO.
-z32 ci o2
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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Forms\Pool spa appl (rev3-04).xls