HomeMy WebLinkAboutS2021-0090 - Permit ApplicationPy_ivp\ryp`ghn
PLEASE PRINT OR TYPE
1. PROJECT ADDRES:
I .� 2-1-1 c—
LEGAL DESCRIPTION
LOT
2. DESCRIPTION OF
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
NOT MAILING ADDRESS)
1:3010111
SWIMMING POOL SPA
Check Appropriate box for Aoolicant
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POOL FENCING ❑
gio,0090
CV
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
ADDRESS
13 ZI-( t cfie ((
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
Pr ZOO
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
Z`1 tUs
ENGINEER'S E-MAIL ADDRESS
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1
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
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BUSINESS LICENSE
STATE LICENSE
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No. �0� ClassCSJ
CONTRACTOR'S E-MAIL ADDRESS
EADDRESS
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STATE ZIP
PHONE NO.
CE USE ONLY
PERMIT NO.
PLAN CHECK NO. tq�t
POOL P/C FEE $
DRAINAGE P/C FEE $
Fortes\Pool spa appl (rev3-04).xls