HomeMy WebLinkAboutS2021-0113 - Permit Application,F gw°°'* WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH C 201 Cl -Ulf
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
24141 GANTIMC10 DR
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK AjtWx00 1`-CJLYIG SFO tluu YsYI--
ESTIMATED $ VALUATION IbDj QQTD
SWIMMING POOL K SPA I, POOL FENCING X DRAINAGE 'A
Check Anorooriate box for
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
?Ajq S NN?I prc-,o by
CITY STATE ZIP
PHONE NO.
❑ 4. ENGINEER'S NAME LAST .FIRST
LICENSE NO.
TI IVDA W.• G -t r✓oRc� ` ,
1 0101 I.1
ADDRESS
E-MAIL ADDRESS
ST
331aS E M19R LOMB ftVG- ST E LDl
till tv\-R n ' -41 •coli
CITY STATE ZIP
PHONE 0.
Ag PMel CPI 92ko s
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
V1 iNA 1 NC10
No. 4:Itftjtp Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
Q 16fttk
CITY STATE ZIP
PHONE NO.
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S INILD AtZ
-E USE ONLY
PERMIT NO. 51m • PLAN CHECK NO. /f0� 1021POOL P/C FEE $ irw we ?• (((��j 1e14,
oil
DRAINAGE P/C FEE
Farms\Pool spa appl (rev3-04).x15V A��s 64�� x�N•