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HomeMy WebLinkAboutS2021-0034 - Permit ApplicationA O4 CY..�pON WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION 0 CITY OF NEWPORT BEACH �7�2/• 00 3y PLEASE PRBUILDING DIVISION INT OR TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) 2-4 6 L C-L�-+- 5T, LOT t `2 BLOCK TRACT G 3qb 2. DESCRIPTIONOF WORK_ 9 / 6 S � ReCR©v T� ESTIMATED $ VALUATION 50 1 C5 d,� ICBG SWIMMING POOL ❑ SPA POOL FENCING ❑ DRAINAGE Check Appropriate box for Annlicant ❑ 3. OWNER'S NAME LAST FIRST 'j?. 1B, ADDRESS OWNER'S E-MAIL ADDRESS 1 Cmc. 5T' u 049/4COONTL T,p} CITY CITY STATE ZIP PHONE NO. 9 949. Com`. X140 4. ENGINEER'S NAME LAST FIRST LICENSE NO. (:; -7 ADDRESS ENGINEER'S E-MAIL ADDRESS 1 I t4FO °��o�Ic�-F(o .CDM CITY STATE s-n1—� ZIP PHONE NO. l—�- . 928c�1 -7114.(504joo 5. CONTRACTOR'S NAME BUSINESS LICENSE STATE LICENSE G�-�InJr)rc51C�r 'RUt�-D 1r�C• mo CZE ADDRESS No.(03Qd57 Clasc X33 �c>,'09 �-/—� CONTRACTOR'S E-MAIL ADDRESS G'2bw'D£Sl(o�••�-gvl`D lrlc:, l� CITY STATE Y\ o�p�ovi T ZIP PHONE NO. 411-�` 19tb CE USE ONLY PERMIT NO. S� -O� PLAN CHECK NO. I ^e-" POOL P/C FEE $ JJJ DRAINAGE P/C FEE $ Fo"MPool spa app] (MV3-04).xls 4'd`Z.2'ZU5- ��r-tori