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S2022-0050 - Permit Application
,�" WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION c nar�oy� " CITY OF NEWPORT BEACH Z2D22���J� BUILDING DIVISION PLEASE PRINT OR TYPE �1. PROJECT0,cb � DRESS (NOT /MAILI ADDRESS) r\ w CA 9e� � �2- LEGAL DESCRIPTION LOT BLOCK TRACT - Oz Z - Z 2. DESCRIPTION OF WORK Re5vr�- ace. -may .1 a Y mance y(' ESTIMATED $ VALUATION A 25; oocD SWIMMING POOL SPA ❑ POOL FENCING ❑ DRAINAGE ❑ Check Appropriate box for Applicant 3. OWNER'S NAME LAST FIRST CA r)) 'I df w ADDRESS . IA1p'vn1`rw 1 1'� 1�1 1b Co tvfn �4 OWNER'S E-MAIL ADDRESS CITY STATE ZIP bin PHONE N0. qui) 27� 33 4. ENGINEER'S NAME LAST FIRST LICENSE NO. ADDRESSvy 0�C�� ENGINEER'S E-MAIL AD SS vth5�carCC�jra Pe��jyh� © � CITY ZIP eac J STATE ZIP PHONE N0. �I`55.. C NTTRAICTOR'S NAME r�� l tA lrl TCs1 i'�� BUSIN/ESS LICENSE 7d�1(J ���C �C STATE LICENSE �_Sy 1 No.L39,36;3i CIa S ADDRESS l%CA w ���, y wee CONTRACTOR'S E-MAIL ADDRESS �al ,. , _ � -e CITY STATE ZIP P ONE NO. :E USE ONLY PERMIT NO. J -:Z-57 PLAN CHECK NO. v �&% "> POOL P/C FEE $ DRAINAGE P/C FEE $ Forms\Pool spa appl (rev3-04).xls