HomeMy WebLinkAboutS2021-0269 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
' Q CITY OF NEWPORT BEACH
BUILDING DIVISION 4,2D21. m Iack
1. NKUJI=G I ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK \-)C P4 C) I-)
SWIMMING POOL Ly SPA ❑
Check Appropriate box for Applicant
ESTIMATED $ VALUATION-I!--�
POOL FENCING ❑
DRAINAGE ❑
3.O'�/Wn�NYER'S NAME LAST FIRST
t C;l Y -T U �uhNe�r—
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
�0a,--\-- CA ca66c)
•7/�6-9I -'9/ 60
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
70�)40 L LAC -14 c -(Z
6-76,S-0
ADDRESS
ENGINEER'S E-MAIL ADDRESS
�-
CITY STATE ZIP
PHONE NO.
,R V1 AV -e C✓ -1- '�') 25,x' "1
'? i 4 , 63 0— G t LY1
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
WYaTP \Zwov �s goc)l_ C--
�
1 6" Sr -7
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
-V L!57T_v✓ C�✓t "!27 Fvd
7% 7/�l 0471
:E USE ONLY (`
PERMIT NO. bv m
� 0
PLAN CHECK NO. <
Ilk
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls