HomeMy WebLinkAboutS2023-0156 - Permit Application.�ii rnry
rya 9, WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LOT Irj n BOCK _ � �I _ ��
TRACT) (04 f�{
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATIONt-40, DOE)
SWIMMING POOL ❑ SPA POOL FENCING ❑ DRAINAGEX
Cheek Annronriate hnY inr Anniiennf
3. OWNER'S NAME
ADDRESS
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FIRST
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OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP PHONE NO.
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25 c� t4 2-7
Z
ENGINEER'S NAME
LAST
FIRSTLICENSE NO.
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HATtl --ZA) S(Qof
ADDRESS
ENGINEER'S ADDRESS
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1 �
`E-MAIL
vhCERf+? bol•C.n. Com
CITY
STATE
ZIP PHO17E NO.
-4 P4
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6? z8o`� 11 1 49-Y) c�
5. CONTRACTOR'S NAME
C�2ra (1 �jZ��l G)
BUSINESS LICENSE I STATE LICENSE
ADDRESS
No. C`J Class
NTRACTOR'S E-MAIL ADDRESS
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CITY
STATE
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ZIP PHONE NO. (9yi YOE
OFFICE USE NLY
PERMIT NO. ♦ UZI -615l
PLAN CHECK NO. K �oz I 7or+
POOL P/C FEE $
DRAINAGE P/C FEE $