HomeMy WebLinkAboutS2021-0062 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
YLLA3t VKINI UK ITFt
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
r° Q M 0�-"(4-c 4
LEGAL DESCRIPTION
LOT
BLOCK
TRACT
S2021.0002
2. DESCRIPTION OF WORK µ' I ��` N SrA Z�
ESTIMATED $ VALUATION Y vna
SWIMMING POOL ❑ SPA ❑ POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Aonlicant
3. OWNER'S NAME LAST FIRST
S-r�t<--� c -Y-- I L
ADDRESS
OWNER'S E-MAIL ADDRESS
$b o L a[
CITY STATE ZIP
PHONE NO.
t-t,61W r'bf-q- arc- 9ubm
94-q 324-- rs 7 %
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
r,+rcAAey-- -tl- a 9
41 `r(P
ADDRESS
ENGINEER'S E-MAIL ADDRESS
Zo ( h(o, T -Li YTL 40 A -4c
CITY STATE ZIP
PHONE NO.
A4 midEl K 1"o-1
-Vr¢-- 6ga-6ro0
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
� to lrtF-ALA5 f86-,�
4
3-r
3 -Lr Jo07 %fl
'4 16 14 o C--S-AA�
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No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
�FY 31 6A cv-tS +`A 4,4-S
1 � �s� r�i C e4b"
CITY STATE ZIP
PHONE NO.
roc.aAk hkC--s ca- 9u yrs
1(4-sq3-1oS*7
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
II POOL P/C FEE $
DRAINAGE P/C FEE $
.Forms\Pool spa appl (rev3-04).xls
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17 1 ► 2,P�21
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