HomeMy WebLinkAboutS2021-0159 - Permit Applicationof "pO WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
'� CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
s� U:
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL
ti sy-
ESTIMATED $ VALUATION / 6 4 o o d
SPAR - -- - POOL FENCING — DRAINAGE [:1
Check Aooronriate box for Aoolicant
3. OWNER'S NAME LAST FIRST
d�/Lo N1 r , N a Log
ADDRESS
Z�- Gc� , (/t d
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
N2�1�6� �-- C � L4 0
P ONE N
- kZ _(� 3 s
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
1)1—f.-/V smr <t / 1 t �COLs'
BUSINESS LICENSE
STATE LICENSE
7/19 Class�3
No.
ADDRESS
2Z7 w. L2I�-�
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
eE G)—) 9`1�67
PHONE NO.
22g5-25-.3 !op`
:E USE ONLY 1 r
PERMIT NO. v I/U V O `C
PLAN CHECK NO.-J I/
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).zls