HomeMy WebLinkAboutS2021-0196 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
' a CITY OF NEWPORT BEACH s 02 019(o
'V.iiU�tp V/
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL D7RIPtTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATION
SWIMMING POOL SPA Xf POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
lZei< ZMA Al I'1YAII fd " <<=�-
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
OU�w Or4T ���«f Ch' _ %?6S�
X60 s,T/ `3l
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
Nt .
CITY U STATE ZIP
PHONE NO.
❑ 5. CONTRACdTOpR''SS� NAME
BUSINESS LICENSE
STATE LICENSE
�y
li7%L/
r
No Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
3 Z 0lj/ l'
CITY STATE ZIP
PHONE NO.
'wk- W �R
9%
;E USE ONLY � �1 ( i
PERMIT NO.-01(%aI�(%d E X10
PLAN CHECK NO. w
POOL P/C FEE $
DRAINAGE P/C FEE $ I)VIA -Wit)
Forms\Pool spa app] (rev3-04).xls