HomeMy WebLinkAboutS2023-0155 - Permit Application®r' � -Ili
"r' 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)
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LEGAL DESCRIPTION
LOT ZLI BLOCK TRACT
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATION
SWIMMING POOL N SPA K POOL FENCING ❑
Check Appropriate box for Applicant
NAGE JX
3. OWNER'S NAME
LAST
FIRST
e.Vn-GS
ADDRESS
OWNER'S E-MAIL ADDRESS
l 1?06
SUF+G od(e &ma., co
CITY
STATE
ZIP
PHONE NO.
N 13
«
qi U60
I .-b7 -- fobs
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
n o d ceL -Two-
A11DRESS
EN NEER'S E-MAIL ADDRESS
2.-C7 E 5T ( o
20 h
f/ d L_5 j5 iNel- r 60vYn
CITY
STATE
rZIP
PHONE NO.
AtJch�--1 m Ca
TZ,go-7
1 ?iq- 3-zy-g/ 72-
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
s tA�Ci
No�' ClassG
ADI)IRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
OFFICE USE ONLY
12o�3 -6 1
PERMIT NO.
S S5
PLAN CHECK NO.
I �j L�
`emu `® �/ - ! 7 �/
POOL P/C FEE $
DRAINAGE P/C FEE $
3
Forms\Pool spa appl (rev3-04).xls