HomeMy WebLinkAboutX2022-0507 - Permit ApplicationX2 v2-2 050"7
e lyp,YYPpk� WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
BUILDING DIVISION
1. HKUJEG I AUUKCSSc(I\IOT MAILING ADDRESS)
Cq o � 2 TL �j � 0 Tom' e
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK A ) lv�:, (1/J 3`I'` 2ac, /` 66
ESTIMATED $ VALUATION 6 ,000
SWIMMING POOL ❑ SPA, POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
SR,(, S k - �> (4 LL c�
ADDR/E�S�S
OWNER'S E-MAIL ADDRESS
('2,, ,- � yr �(a -r
"
CITY \ STATE ZIP
aK-F`o.,�-vo CA -7(o)
PHONE NO.
",lo9 y -� �- -1Ro,
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
7
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C5 C-Iql L)
ADDRESS r J
ENGINEER'S E-MAIL ADDRESS c -CtLG'Z3
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
OFFICE USE ONLY — o0go �2o2Z-61q 7
PERMIT NO. LL �
PLAN CHECK NO. I ,/ 22- om b [45'2_ZGZZ
P1 � SZ -ZoZZ
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls