HomeMy WebLinkAboutS2021-0081 - Permit Application' .°"> WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION V 15* Au -
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT ��MAILING ADDRESS)
�,
I ' 161 ��LeYi
LEGAL DESCRIPTION
LOT BLOCK d` %TRACT
2. DESCRIPTION OF WORK �� �� 1 �� GC^ I ,
d IW ESTIMATED $ VALUATION `10� �
SWIMMING POOL SPA POOL FENCING ❑ DRAINAGE ❑
Check Aoorooriate box for Aooiicanntt
3. OWNER'S NAME LAST FIRST
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ADDRESS
A���rl
O WNER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
zx, 45
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4. ENGINEER'S NAME LAST FIR
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LICENSENO.
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ADDRESS
GINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
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5. CONTRACTOR'S NAME
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ENSE
BUSINESS LICENSE
STATE LICENSE
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ADDRESS
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CONTRACTOR'S E-MAIL ADDRESS
Iv.
CITY STATE ZIP
Sum c��r'� e c� c( i
PHONE NO.
(9)0 75z' ---707Y
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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Forms\Pool spa appl (rev3-04).xls