HomeMy WebLinkAboutS2023-0150 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LOT BLOCK
2. DESCRIPTION OF WORK1/�/
5' x q'
SWIMMING POOL ❑ SPA ❑
Check Appropriate box for Applicant
TRACT
✓�ZI'I G�1� (x7/L (3 21 ✓> 6 l%
ESTIMATED $ VALUATION-1.
/O / 0O�
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME
LAST
FIRST
MAcq�AU
ADDRESS
OWNER'S E-MAIL ADDRESS
�'60 G W � �2rt rmts
P Z
CITY
STATE
ZIP
PHONE NO.
k\i'?Q
C-A-
011Z6(--,O
q K�gnx, —4�� l
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
jc o Z-0 `r�-z
jGcN
G GH -�-Gle,
ADDRESS
ENGINEER'S E-MAIL ADDRESS
4t D C Et->-r �j
L-
CITY
STATE
ZIP
PHONE NO.
(-kPZC-A 7 i--
C1
qZa-�o
5. CONTRACTOR'S NAME
BUSISINEESSLICENSE
IICENSE
STAT/ET ESE
� VSN
Noft jH-ClasS3
A—DDDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
?
CA-
g26(,D3
9`-n �im �- -GL IB_
:E USE ONLY
PERMIT NO. S�roz�, QI 5v
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Fo"s\Pool spa appl (rev3-04).xls