HomeMy WebLinkAboutS2021-0106 - Permit ApplicationWORKSHEEZ FOR PQpL COMBINATION PERMIT APPLICATION
ZOZ ( CITY OF NEWPORT BEACH
FIrUMifiT
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS) ��))
S - r Cor n q dr-1 N
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF
nI_ _ it
Neu) S' felc�i,�iny Cj)&J) Q�rOx.
SWIMMING POOL SPA M
Check ADDroDriate box for Anolicant
$ VALUATIONJ a S, 000
FENCING ❑ DRAINAGE ❑
03. OWNER'S NAME LAST FIRST
c n O/bc
ADDRESS
OWNER'S E-MAIL ADDRESS
DSOO Cloro(vi. Jd
-
CITY STATE ZIP
PHONE NO.
Comoo Aral Nor C 0 q s
qqa- ):3 j,3�
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
® 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
-
AL
No. Class
_
ADDREISSS
—AL _�
CONTRACTOR'S E-MAIL ADDRESS
\
l S .
CITY STATE ZIP
PHONE NO.
,E USE ONLY
PERMIT NO.
PLAN CHECK NO. c n
POOL P/C FEE $
DRAINAGE P/C FEE $
rormswool spa appl (rev3-04).xls