HomeMy WebLinkAboutS2022-0138 - Permit Application4 aEwPoq�' WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
201) Ya(,� he lee -
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL E� SPA
Check Appropriate box for Applicant
ESTIMATED $ VALUATION 1, ow
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
lvew �1� �eac� 64 11660
PHONE NO.
ft - HI - 3577
4. ENGINEER'S NAME LAST^ �FIRST
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LICENSE NO
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l h u1 �i 1 I"IAEkki`
ADDRESS
l (10I 4VM
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
64' `g207
PHONE NO.
1 7)W 630 61)
5. CONTRACTOR'S NAME i
vIV\ �IGV
BUSINESS LICENSE
STATE LICENSE _
I��LII�CIasC0
No.
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
[��C��uv\ Ue) v M `Uq l
PHONE NO.
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OFFICE USE ONLY Zo2 Z — O
PERMIT NO. j g
PLAN CHECK NO. 15 q 3 ..- z-AZ Z
POOL P/C FEE $
DRAINAGE P/C FEE $
DZorz- 0312
Forms\Pool spa appl (rev3-04).xls