HomeMy WebLinkAboutXR2023-0641 - Permit Applicationk U as
"? WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
s BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
L-SOS P . ,
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK �ivC5 PDO 1 Me t 11il
ESTIMATED $ VALUATION L 4 UD
SWIMMING POOL ❑ SPA ❑ POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
NLw ar Px�c�� G Cl iD Z b
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
`I^Ofnhl/�\ � T--NC
�9�1
No. 96,iIZg Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
�¢� 6fow i U4%l�� �;� Q-N 209
'a.Y'Yvd
Pa�—:K-N6(D Cox 1��
CITY STATE ZIP
PHONE NO.
ka 1L cN . �1RAq
9`19 233 -09.2
OFFICE USE ONLY7
PERMIT NO. �r (� �� L
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls