HomeMy WebLinkAboutX2021-1410 - Permit ApplicationyF `YP"R m WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACHZoz� A �� 10
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
202y( Sppuc€ Aof,
LEGAL DESCRIPTION
LOT I BLOCK TRACT
2. DESCRIPTION OF WORK QNQ Qoaf A :lnfi(L60i1j moi.>nl�D`
ESTIMATED $ VALUATION q , Wc>
SWIMMING POOL SPA POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
M' 3. OWNER'S NAME LAST FIRST
J Do
ADDRESS
OWNER'S E-MAIL ADDRESS
20 ZZ4 3 Ppwr-& A \16-
CITY STATE ZIP
PHONE NO.
0 q &'r4 'ac- Ac
c)4 7 3c ° ( c (
❑ 4. ENGINEER'S NAME LAST FIRST
L CENSE NO.
OritOeWSAL FP7 fyee. '[i(
ADDRESS
ENGINEER'S E-MAIL ADDRESS
(4-cxx> o,4� (0b
ne&
CITY STATE ZIP
PHONE NO.
-So1,�4A A,vA CSA `1 405'
-24(�-:Tf3a -044a Li
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
cj0ow C,:,AS1- c0(
No. C S3 Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS 94o935
3 bS 1 KCA)A 1(Y A jf
't2bsr4ok c (� co%-,
CITY STATE ZIP
P/HONE NO.
A j( lq o&LIA C>'1 r co i
l x(02)
:E USE ONLY n
PERMIT NO.
PLAN CHECK NO. 0 ,l i 1�' V '�-1
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls