HomeMy WebLinkAboutS2023-0051 - Permit Applicationr°*rA WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
R CITY OF NEWPORT BEACH
BUILDING DIVISION
VLLAAc rKIN1 UK 1Trt
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
Al
ck
C✓e0.✓\ 1aVV
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK e
ESTIMATED $ VALUATION
SWIMMING POOL SPA N POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S -MAIL ADDRESS
6°N %i1ha2 IL
rIG {(-Y1Z1S O✓1 C� Cq. i"l o✓1L L'7.Gd ✓h
CITY STATE ZIP
PHONE NO.
Ykvc,,fi Der"k CA RZ663
4. E GIN ER'S NAME LAST FIRST
LICENSE NO.
�
+ e G s^
K6051
ADDRESS
ENGINEER'S E-MAIL ADDRESS
1101 N Tv;-h,, Ave
MGi� 17o ll eel , CGM
CITY STATE ZIP
PHONE NO.
aHG ^1 C i2�Sc7
-710 6'�O (,(00
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
.X.�IUarL Fr,1$ Inc-
No. V?3L5 Class G53
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
PG (3oX 28N ?i %
J,r" bor'I
CITY STATE ZIP
JGII i-H Am, C �i 2 7 °I
IPHONENO.
(i m) 71 `1
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL PIC FEE $
DRAINAGE PIC FEE $
Forms\Pool spa appl (rev3-04).xls