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S2022-0056 - Permit Application
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION = CITY OF NEWPORT BEACH BUILDING DIVISION PLEASE PRINT OR TYP/ >:� 1. PROJECT ADDRES AILING ADDRESS) M-TjllorA /X A).1,2 A A PAil `I LIA LOT 2. DESCRIPTION OF WORK ESTIMATED TRACT UL 5 ' TION) SWIMMING POOL (/�� SPA [2-' POOL FENCING '11� DRAINAGE-< Check Appropriate box for Applicant ❑ 3. OWNER'S NAME LAST FIRST 16A/I Z K ADDRESS OWNER'S E-MAIL ADDRESS I0 7-/fIIAIA!A9) CITY STATE ZIP PHONE NO. V ul O EA12 Z k� 4. ENGINEER'S NAME FIRST LICE/NSE NO. / ITA � IIX5O � BLAST /'x5ez- I �� dJXIM� ckj/, ADDRESS ENGINEER'S E-MAIL ADDRESS `, 13AI V I/A �� # sS MIAo e MAS C ,6-4 &: e�Vl CITY STATE PHONENO. )/�Al AI U L Gig . �jZIP{� 7 wl i �J3SS_5 5. CONTRACTOR'S NAME BUSINESS LICENSE STATE LICENSE �r �} !' N-171,(�11a �'MAINj/ ) N4,4 V;'% Class3 ADDRESS CONTRACTOR'S E-MAIL ADDRESS ,� Z % /� ISS��� C�� C% 7"e1v mxxi1,yr � YAHe©, LCr/d. CITY STATE ZIP PHONE NO. OFFICE USE ONLY PERMIT NO. U" Y,, PLAN CHECK NO. POOL P/C FEE $(�