HomeMy WebLinkAboutXR2023-1872 - Permit Application°"r" WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION _
CITY OF NEWPORT BEACH `
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
2 q
c)L g
LEGAL DESCRIPTION Z,.l L
LOT BLOCK TRACT
2. DESCRIPTION OF WORK N Q L.
ESTIMATED $ VALUATION SG
SWIMMING POOL SPA I� POOL FENCING ❑ DRAINAGE E
Check Aanromiate box for Applicant
3. OWNER'S NAME LAST FIRST
C t,( viner Scot t—
ADDRESS
OWNER'S E-MAIL ADDRESS
�`1G�-! � rCJ {-
Sc�-t+c► wLe- 2 ��tw.�, (.c��
CITY STATE ZIP
PH E NO.
rJe-� r t 2e.c L, 6--t a
G� 783 - SS`f I
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADD SS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
,.,,
l6 &! 'Wn
N0.108S 5 Class e
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
��I Glke,�o
n AQVI OolCp w-4.� •C•,,.,
CITY STATE ZIP
PHO NO.
SS�0.•/ Vy eJa � 57a
cl�-l77-6/(��
:E USE ONLY
PERMIT NO.
i
PLAN CHECK NO.
POOL P/C FEE $
9
DRAINAGE P/C FEE $
FormsWool spa appl (rev3-04).xls