HomeMy WebLinkAboutS2021-0287 - Permit Applicationcao
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK N)E-l) Vi - 6 C,,/1'S � C-- c-c-2T1e-/('1-c-
L (euC--S ESTIMATED $ VALUATION
SWIMMING POOL �f- SPA Z!f- POOL FENCING ❑
Check Appropriate box for Applicant
DRAINAGE ❑
3. OWNER'S NAME
LAST
FIRST
4c')c,
S6-
ADDRESS
OWNER'S E-MAIL ADDRESS
Loc,%r(t fyw),7 L�l11l ,co✓n
CITY
STATE
ZIP
PHONE NO.
cf-J 06--t ac (+
9,z,(. 6 o
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
Zt{ti-A) Gytto
ADDRESS
ENGINEER'S E-MAIL ADDRESS
OOoO Cj F�-R-i2 y 6'4✓C,
(06
J1 14-E
CITY
STATE
ZIP
PHONE NO.
PJ71� Awl"
C ! 1 -7 OJT
C((!C� %�i�-O�/Zt
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE 4
S fA'T 2UL 7 o
cs 3
No. U 2 to l2 Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
C/o 6 G Beou ✓ r
5lgplc(S cc, -e- L two,' I• Cs4-7
CITY
STATE
ZIP
PHONE NO.
lV" q>1
Z57
qi"lc72b5- 8320
,E USE ONLY C Z�,-),Z r2oZ I - U 55 q
PERMIT NO. J
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
c—ID--i—e. 1I—A nAl-1. ,n9 1 -bb/% .ACi _ir;-7i
\-�;0,71
--r . ,� t /1
11
- '- �it? e-( v C-
277
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