HomeMy WebLinkAboutS2023-0068 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
Ca H., c4- 2S
LEGAL DESCRIPTION
LOT BLOCK TRACT
DESCRIPTION2. OF • -9J►r=-�� 1d�)77W7171r1�1�,^=�_s—��
ESTIMATED $ VALUATION
SWIMMING -•• \ -•• ■ RAiNAGE�.
CheckApproprlate box for Applicant
3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
Cd { ( fA J, 9 Z5
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
T-b0L DYEI�eIti�16- C44cTbPi
`74oc4-5
ADDRESS
ENGINEER'S E-MAIL ADDRESS
I�1 �,I
C-Kvis(g
CITY STATE ZIP
PHONE O.
-1) (0,5® on
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
F70J1 l`)0,A" t C'S
Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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saraRj 61a ifi C�@ rnaA'�<COM
CITY STATE ZIP
PHONE NO.
GV u vE 2`rD o c,4-
a L19 ttU F a7
;E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
(400-`r75 -oo6 5
Forms\Pool spa appl (rev3-04).xls