HomeMy WebLinkAboutS2021-0003 - Permit ApplicationNYYV19" F,
.aN WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
�C F SZO�I DOD3
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
4006 fLC7T Le
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATION ZCy
SWIMMING POOL SPAT POOL FENCING ❑ DRAINAGE ❑
Check Aoorooriate box for AnDlicant
3. OWNER'S NAME
LAST
FIRST
oR-
ADDRESS
1-10 061' rtl Z7
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5. CONTRACTOR'S NAME }
BUSINESS LICENSE
STATE LICENSE
IN05.--;109-�
Class S3
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
2 Z 7 L �/..
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-te4 - (6) tel ) S j�SOu
CITY
STATE
ZIP
PHONE NO.
:E USE ONLY
PERMIT NO. �e��
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa app] (rev3-04).xls