HomeMy WebLinkAboutS2022-0131 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
r CITY OF NEWPORT BEACH
µN. SZo22-b131
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
/T Y V Poll T c-// A 9 5
LOT BLOCK
2. DESCRIPTION OF WORK /1 ~ /197r7
SWIMMING POOL W SPA Re
Check Appropriate box for Applicant
TRACT
Js°A 3%
_ ESTIMATED $ VALL
POOL FENCING ❑
5
Zep., a0D
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY STATE Z
PHONEN co
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(,qYq `Y2Z-.S'755
4. ENGINEER'S NAME (--AG®L eA. §l N C-V. Nq)FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
/zDi /s/. rviTin/ Ave
AIATTT(0 eA . c"onl
CITY STATE ZIP
PHONE NO
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(7��)00-&ID
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
91s7.3ZS C-S
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
/. D. 28g3%
AoM(oJC`iw.4rz poll rorii
CITY STATE ZIP
PHONE N
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ty ov72 -�150
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO. I N, 96 - ` O
POOL P/C FEE $ M6,06
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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