HomeMy WebLinkAboutS2021-0163 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION ('+n o�1 �oI' nb
i CITY OF NEWPORT BEACH J OL L W
r., BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
t -I I I -!�- ?-,j � Lvb
LEGAL DESCRIPTION
LOT BLOCK TRACT �lt;o
2. DESCRIPTION OF WORK 5 W l MM (KX7 900 L. `I- SP-&
ML 6ASL/�[ S LP" C•� _ 3- 6 0V -r �T ESTIMATED $ VALUATION y BiMU
SWIMMING POOL Nf SPA &T' POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME
LAST
FIRST
l\-lvI-
SCr 1J
ADDRESS
I-) I1 J.wIcJCT �3Wp
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
"c-vj-Pof:-T C3CACA1
d .P
g 2668
')Lf)- 28()-8L1`I2-
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
C
q
ADDRESS
ENGINEER'S E-MAIL ADDRESS
126 1 -N VST I IJ
ASI6
M I tJ FrJ (° fto(- *-)CA* Ca *�
CITY
STATE
ZIP
PHONE NO.
At-lQHerr,
GA
C:rZ�o"1
,I�-�3o-6►00
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
SUiJs>31 OoLS+
C-133
N1 Cs
3735
ADDRESS
►yG0
Z
CONTRACTOR'S E-MAIL ADDRESS
Kai !ate
�c',Q1<3C V°o y 11229,9w-wIL. r -O
CITY
STATE
ZIP
PHONE NO.
CA,
92S41
H1H -313 l3®�
CERMMI TNOY oI OY N -n1204
r '
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $ 1
Forms\Pool spa app] (rev3-04).x]s