HomeMy WebLinkAboutS2021-0276 - Permit Application09*,
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
S" Er l - 02/57& BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
vel^UA
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK L�%e'Aj 5P"+ it' -/I / i.✓ 4 3z +/ (fJ°I'(ejqyevlc' lgt"G"Vl
P_ Lt (= --", � q1 ESTIMATED Zoo
�- 2r,4A cvbpn �- )
SWIMMING POOL ❑ SPA POOL FENCING ❑ DRAINAGE IL.V
Check Annromiate box for Aoolicant
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITYSTATE ZIP
PHONE NO.
a
1 (5 Ci*- -1cIS-
❑ 4. ENGINEER'S NAMMEE/ LAST FIRST
LICENSE NO.
L
ADDRESS A ,,e
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
PI-, e le,&A K -A
?SLA 6 TC''- c% k O c>
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATTEq
,30 - 35
T5�3�� 3'� 6 `�
/LICENSE
No. � O1 Class'
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
_i o %t v c^.✓
CITY STATE ZIP
PHONE NO.
(OFFICE USE ONLY
PERMIT NO. , 52U2(.�Z'l(� ,�,p2�o� 1 av-0
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls