HomeMy WebLinkAboutS2021-0117 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH (J20'L� ••�� �'}
BUILDING DIVISION
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1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF
SWIMMING POOL C9/
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SPA [9'
Check Appropriate box for Applicant
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ESTIMATED $ VALUA
POOL FENCING ❑
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DRAINAGE ❑
3. OWNER'S NAME
LAST
FIRST
APAP ui;rZ- T.QA(-`
ADDR�E/SSAr
4-
OWNER'S E-MAIL ADDRESS
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cA.
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CITY
STATE
ZIP
PHONE VO.
Newl v /-L 2c.,4'r" ,
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926 6 0
5oVV 273�- b733
B-4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
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CH.2/ J 7'0,,014
Pr
74 00,3
ADDRESS
ENGINEER'S E-MAIL ADDRESS
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CITY
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STATE STATE
C,�l
ZIP
47,
PHONE O.
t,7/ )(030 6lflo
En. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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967375
No.9�'32rClass�S
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY
STATE
ZIPrg-V%j)
NO.
Y4.4V 7-d • (AIA
C -,d ,
9Z 799
a'T2- O V r
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).x15
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