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HomeMy WebLinkAboutS2023-0016 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION CITY OF NEWPORT BEACH ' BUILDING DIVISION PLEASE PRINT OR TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) LEGAL DESCRIPTION LOT BLOCK TRACT 2. DESCRIPTION OF WORK 0 W kt>0L- I�� X 3 Zr , 6t�>+ 0Zu-- TG f2ve P►G t l Ve D ('- f OV P.V�_ ESTIMATED $ VALUATION 4-90/ 0O 0 SWIMMING POOL ©/ SPA POOL FENCING ElDRAINAGE (�/ Check Annrooriate boz for Aoolicant 3. OWNER'S NAME _ LAST - FIRST — `�(T c—St��1— I�t�r'�L IZ Prv� 17 M � Gl�l ✓h-�� ADDRESS -j �/� OWNER'S E-MAIL ADDRESS / CITY STATE ZIP PHONE NO. A%-I--+�-, cA— 17660 Fj 4. ENGINEER'S NAME LAST FIRST LICENSE NO. Z :K>iepeo avi,-4v k&V 94-1C)b3 ADDRESS ENGINEER'S E-MAIL ADDRESS �Zoi CITY STATE ZIP O PHNE NO. Zhu q-' its 6 — d eU 5. CONTRACTOR'S NAME BUSINESS LICENSE STATE LICENSE poot I.7WSSM�.J�bpl No. 6y� Class ADDRESS CONTRACTOR'S E-MAIL ADDRESS �-7 '�: �XJU-t_V r2%1 �— CITY STATE ZIP PHONE NO. P I?::> C A-- 1�7 1 q� � �- 66 --t 'E USE ONLY 5 Z 6 2 3-- ®G 1 PERMIT N0. //�� PLAN CHECK NO. C 2�/Z 72 -- ®� 15 1 q POOL P/C FEE $ DRAINAGE P/C FEE $ G Forms\Pool spa appl (rev3-04). As