HomeMy WebLinkAboutS2021-0280 - Permit Application04
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RKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH mi-osoBUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
d1m SErr'a Drive
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK� IJ� 6eiv J?ok $ehIJ4 $%E144e Lt --,P 4!q- / e
iA CyV- , 4,kime tw , av4 ;N' G� 4omwt f1i ESTIMATED $ VALUATION ^5•00
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SWIMMING POOL SPA ❑ POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
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�Op.wh CpW ( t4n^ll• Cam
CITY STATE ZIP
P ONE.NO.
Covov,& JaA fA*-,r CA} `12625
9 — $'g ^ 332
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS-
ENGINEER'S E-MAIL ADDRESS
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M.Pfl 2 0*01 . eof't�
CITY STATE ZIP
P ONE NO.
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`j14} - Fred ^ bl<<k
5. CONTRACTOR'S NAME s
BUSINESS LICENSE
STATE LICENSE CZ1
A{am �i1V►i o, S \
No.S-7 VT10 Class 1
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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Ul N. Ct4l�oh ��
.A\wm. okscRvtijb( Po, aws�arrlt. cert,
CITY STATE ZIPPHONE
NO.
G4 i�-71-7114-
LHS-OT47
OFFICE USE ONLY
PERMIT NO. wA, 09
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls