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HomeMy WebLinkAboutS2021-0036 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION CITY OF NEWPORT BEi BUILDING DIVISION PLEASE PRINT OR TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) 1918 port Plc`c@ I New or+ Reack LEGAL DESCRIPTION LOT T / BLOCK TRACT 77iV 3Z 2.DESCRIPTION OtFWORK R`efietiSh alaSl�etr ;11 P, , ri.place SAA lemYeV— om cC 1 p vwe P ESTIMATED $ VALUATION 000 SWIMMING POOL ❑ SPA POOL FENCING ❑ DRAINAGE ❑ Check Aooroorlate box for Applicant OWNER'S NAME LAST FIRST MolleHko f j'vtzk ADDRESS let? Port T-Pyr;, Place OWNER'S E-MAIL ADDRESS Teack.mollehkopf(EJ m4d.co CITY STATE ZIP Ntu.Por4 9-e&Cik CA 0/Z6W PHONE NO. bZ6.705, y359 4. ENGINEER'S NAME LAST FIRST LICENSE NO. ADDRESS ENGINEER'S E-MAIL ADDRESS CITY STATE ZIP PHONE NO. ® 5. CONTRACTOR'S NAME BUSINESS LICENSE STAVE LICENSE No. Class ADDRESS CONTRACTOR'S E-MAIL ADDRESS STATE ZIP ::17 PHONE NO. OFFICE USE ONLY PERMIT NO. PLAN CHECK NO. POOL P/C FEE $ 2c -) z DRAINAGE P/C FEE $ Forms\Pool spa appl (rev3-04).xls