HomeMy WebLinkAboutS2021-0180 - Permit Application (2)yso z
op WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
VLCASC YKIN I UK I YPk - — - • —
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LOT
2. DESCRIPTION OF WORK
BLOCK
SWIMMING POOL Eg/ SPA I�
Check Appropriate box for Applicant
TRACT
;5004 6700 Z
_ ESTIMATED $ VALUATION VVQ
POOL FENCING ❑ DRAINAGE
ffT. OWNER'S NAME LAST FIRST
45 I L.V) P -N/ ✓A kE
ADDRESS
OWNER'S E-MAIL ADDRESS
.761,o ?3.arrwvP R
CITY STATE ZIP
PHONE NO.
!✓Pw q z $-4,0
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
T-✓u.v1ArCPA/ AI /3TTHM&,-/
��65
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE ��
5
No. Class
ADDRESS ry�
/R, o. FJd>< ZFy�7
CONTRACTOR'S E-MAIL ADDRESS
�5`c%jwgrZ YJCo/1.
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CITY STATE ZIP
Qyxi
PHONE NO.
1772
.5"4wrrw C4 92.79gt
9eFq -o SDs
:E USE ONLY
PERMIT NO. \V� J V 4V'`^I V('fyi+�'C�l�j �%�jRli bV�L✓
PLAN CHECK NO.
POOL P/C FEE $ ✓ ��
DRAINAGE P/C FEE $
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