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S2022-0023 - Permit Application (2)
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION 6-4 d CITY OF NEWPORT BEACH "" BUILDING DIVISION PLEASE PRINT OR TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) I �--5U IZ C S✓lI rn -t) i%L LEGAL DESCRIPTION LOT BLOCK TRACT 2. DESCRIPTION OF WORK OC)L2g l�/ 13 ,(k) -I '36 / fn-15co jpl IIw Gam, V�5 f"^ Q f'i�C +U �J7g P'9 P-- ESTIMATED$VALUATION L+t j-joo7 SWIMMING POOL a5/"' SPA E POOL FENCING ❑ DRAINAGE [� Check Appropriate box for Applicant 3. OWNER'S NAME LAST FIRST ADDRESSOWNER'S (x-56 E-MAIL ADDRESS CITY NPf3 STATE cA4 ZIP Llzb6a PHONE NO. 1�-� --�qS-_ q I 4. ENGINEER'S NAME ..' LAST FIRST c LICENSE NO. 1C9iALKL^I%L.L'� ADDRESS (201 . (U� � kv� ENGINEER'S E-MAIL ADDRESS CITY��i (-V ✓" r STATE ( Fi 1A � ZI�� z PHONE NO. R°A 63o - 6 -1 5. CONTRACTOR'S NAME .. 45-1 CBUSINESS LICENSE/ STATE LICENSE Pro—(,� 60 f. l Is-3qbq No. ©�V� Class,�3 ADDRESS /� : youei/ i/" ✓ f� 1�' CONTRACTORS E-MAIL ADDRESS 6A v O1 jCG e 50 v1/1G 11. CITY JVP STATE Cdr- ZIP 92663 PHONE NO. CE USE ONLY PERMIT NO. EZ(1ZZ. • O021 �um - pgt7j sLa2zo PLAN CHECK NO. POOL P/C FEE $ DRAINAGE P/C FEE $ Forms\Pool spa appl (rev3-04).As c du