HomeMy WebLinkAboutS2022-0093 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
U.,.� CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
1112 (ViVe
LOT
BLOCK
2. DESCRIPTION OF WORK Ni---LJ POOL- + -SPA-
TRACT
ESTIMATED $ VALUATION &). G13
SWIMMING POOL [ SPA POOL FENCING ❑
Check Appropriate box for Applicant
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
DI GtrzoNto -PAL)!®
ADDRESS
OWNER'S E-MAIL ADDRESS
1 I Z �JILIJ6JG�j�I E— P9-
CITY STATE ZIP
PHONE NO.
NF_LJPofz-c BE,4,L (fA 9262S
3to • 713 • 3706
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
I2Ut N. To i3rW ,44i:-:--
CITY STATE ZIP
PHONE NO.
AN I Nk Ch ctso6-7
I -T14 •630 . (1 ac,
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
Ned R Z f va c,S t� L
gG132S e
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
J e, SU-IvIk-2Z-+Pd7 L:5 4a-4,A
Fo $e,,k 29j Z
(nt -
CITY STATE ZIP
PHONE NO.
'SA,WA kNAlz c4- gZ7qI
-TIA.2-i1
OFFICE USE ONLY
PERMIT NO. S C CS✓�/ ((�� 3
PLAN CHECK NO.�—
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls ���. 0 Z- V 7