HomeMy WebLinkAboutS2023-0195 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
r CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK �• l) TRACT
2. DESCRIPTION OF WORK Iv -:y Q r t IS it I '�-' x 13 vJ (4 -6 " ►-M SC k2
ESTIMATED/$ VALUATION Y S�COOO
SWIMMING POOL ❑ SPA POOL FENCING ❑ DRAINAGE [�
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3. OWNER'S NAME LAST
FIRST
l
I� h
ADDRESS
l KC, C t/i orz
OWNER'S E-MAIL ADDRESS
CITY STATE
N P>3 C-1�-
ZIP
Ci ZG(>Q
PHONE NO.
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4. ENGINEER'S NAME LAST
FIRST
LICENSE NO.
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456�
ADDRESS
ENGINEER'S E-MAIL ADDRESS
kz r, Al
CITY STATE
ZIP
PHONE NO.
5. CONTRACTOR4S NA.MMEr
BUSINESS LICENSE
STATE LICENSE
C
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Gv �� ` No.(q
ADDRESS
Class J
CONTRACTOR'S E-MAIL ADDRESS
�533 '�>Gv-ev DZ
CITY STATE ZIP
C�— `tZ��C�
PHONE NO.
OI 7 -6
OFFICE USE ONLY
PERMIT NO.
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PLAN CHECK NO.�j�J'
V
POOL P/C FEE $
DRAINAGE P/C FEE $
rormslPool spa appl (rev3-04).xls