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HomeMy WebLinkAboutS2021-0124 - Permit Application4 $"°°" WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION 0 n r n S2o2(-nl2q '�.z,.�,,��,° CITY OF NEWPORT BEACH BUILDING DIVISION PLEASE PRINT OR TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) JAOIUCIL LEGAL DESCRIPTION LOT BLOCK TRACT 2. DESCRIPTION OF $ VALUATION SDI 000 SWIMMING POOL] SPA ❑ POOL FENCING ❑ DRAINAGE ❑ Check Aoorooriate box for Applicant 3. OWNER'S NAME LAST FIRST VON hbrc ADDRESS ��o I P©(+ Iohee%r X OWNER'S E-MAIL ADDRESS CITY STATE ZIP PHONE NO. N 0a+ h 6q Z66 4. ENGINEER'S NAME LAST FIRST LICENSE NO. Cadvr Tcaj ,67656 ADDRESS ENGINEER'S E-MAI ADDRESS I201 A). To5tilq &4 CITY STATE ZIP PHONE NO. 5. CONTRACTOR'S NAME BUSINESS LICENSE STA�TEE LICENSE D AT/✓�% 10 No.wD ADDRESS CONTRACTOR'S E-MAIL ADDRESS �. CITY STATE ZIP PHONE NO. `01A-3q3::05E� OFFICE USE ONLY PERMIT NO.,�), PLAN CHECK NO. POOL P/C FEE $V)% C� DRAINAGE P/C FEE $ r' 2 62-1 -C I q4 ` noel