HomeMy WebLinkAboutS2022-0127 - Permit Application'""" WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE R i a
1. PROJECT ADDRESS (NO AILINGADDRESnS)�
LOT BLOCK
2. DESCRIPTION OF WORK.
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3 3 SJ nT Sir Far{ ESTIMATED $ VALUATION 3c', 060
SWIMMING POOL SPA POOL FENCING ❑ DRAINAGE
Check Appropriate box for Annlicant
3. OWNER'S NAME LAST FIRST
2S21 ll,;n LLC
ADDRESS
OWNER'S E-MAIL ADDRESS
PKI IV & PCclrPe ,cx:v
CITY STATE ZIP
ONE NO.
79)
4. ENGINEER'S NAME LAST (��]�y)e` FIRST
LICE SE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
P FibN K NO.
5. CONTRACTOR'S NAM
BUSINESS LICENSE
STATE LICENSE
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`NI?S�Me:� �
5= 5 CSj
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No.. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
4,f\N 0 ow weo dp(S l 1. (0n
CITY STATE ZIP
PHONE NO.
'E USE ONLY PERMIT NO.
Ut�uj-.t- NL 61 — 4�1
PLAN CHECK NO. kkk
POOL P/C FEE $ L �C (�✓ f
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls