HomeMy WebLinkAboutXC2023-0057 - Permit Application" WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
`f 7 o Lv co L,'&T c 0R NFkv c0 Z%QF�Cir`
LEGAL DESCRIPTION :77:71
LOT
BLOCK
TRACT
2. DESCRIPTION OF WORK _/427t +ce- /5UOL E(k//PMENT
ESTIMATED $ VALUATION Sod, daU
SWIMMING POOL ❑ SPA ❑ POOL FENCING ❑ DRAINAGE ❑
Check ADDroDriate box for Annlicant
3. OWNER'S NAME LAST FiRsr
ON-c-i' 6PcO �� co u,Llva/7Y �1 �Sa%¢T/oN
ADDRESS
OWNER'S E-MAIL ADDRESS
,�17 D zo
/�l l �` � , �i6h
CITY STATE vv ZIP
HONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
A/*/rw,!5 t c-,& 4OA477c- 7��G4(41,
ADDRESS
1S6 olc4lv6E (5A4 to / 3;�Z
ENGINEER'S E-MAIL ADDRESS
2_ ipskS",�-6 .APeu= 4i4
CITY STATE ZIP
PHONE NO.
c1q
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
/
, gwvc- 5��1� ('
No. Class
ADDRESS
WMTRACTORS E-MAIL ADDRESS
OW oil
32236 ,,� A�Ez o� 4A
CITY STATE ZIP
AN C,q�rl� Cr4 ?/;LL7s
PHONE NO.
OFFICE USE ONLY
PERMIT NO. XF!j0 7
PLAN CHECK NO. Mo
POOL P/C FEE $� ,?,Q
DRAINAGE P/C FEE $
rorms,.rooi spa apPI (reVJ-U4), xls