HomeMy WebLinkAboutS2023-0024 - Permit Applicationa"`°'r WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
�"°a�' BUILDING DIVISION
YLCNac rmillI vm I rrc
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION 74-PM : D e/c1- 2s 3._1
LOT 76 BLOCK TRACT1'2-
2. DESCRIPTION OF WORKCO/,)ST sPA- A t/SF Jj C-A-S -16 i514Z&�- G'/7-
gb O"C7,L-ESTIMATED$VALUATIO 2Sro�)
SWIMMING POOL ❑ SPA POOL FENCING ❑ DRAINAGE
Check APPrODriate box for Applicant
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
Dlo Tel rZ� 7-C- i��
CITY STATE ZIP
PHONE NO.
IVB CA- SZ2
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
TI -?�-o /y Ps 0 �
�(a S
ADDRESS
ENGINEER'S E-MAIL ADDRESS
12,01 N . ?U s r/ �
To J)L--) L e
CITY STATE ZIP
PHONE NO.
AA-) 4 cl�
7/d/(,3o�,/00
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
_ 7&
<Z �
N o��3'? > --Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
s ra4) bta4-rz i �cglrb4.iA c-oA-f
�971 L 1�S
9L o w
CITY STATE ZIP
PHONE NO.
0GL �6e 92��
2' q9� 012
OE USE ONLY
PERMIT NO.
PLAN CHECK NO.
T'
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls