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Home My WebLink AboutS2023-0143 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION CITY OF NEWPORT BEACH BUILDING DIVISION PLEASE PRINT OR TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) IIL�K Pai-CC Se413oiAV-VIQ wV� LOT BLOCK TRACT 2. DESCRIPTION OF WORK �j f�r O lr f (9as 4v ' V'e &- P FCC --jr T�fS6, HNY7 {�7We LA G ESTIMATED $ VALUATION �ccL 2 %LPA Loll IAA. % SWIMMING POOL ®/ SPA � G✓ ✓ POOL FENCING ❑ Check Appropriate box for Applicant efe oo v DRAINAGE m/ 3. OWNER'S NAME LAST FIRST \ l ADDRESS OWNER'S E-MAIL ADDRESS [0"�4 (f Q-1 Se�Y%cw✓n� W� CITY STATE ZIP PHONE NO. j 1P3 Cq— ©(Z6 �o 4. ENGINEER'S NAME LAST FIRST LICENSE f y695i ADDRESS ENGINEER'S E-MAIL ADDRESS LA5r{ rh A1/� CITY STATE ZIP PHONE NO. (V ew I wl cr'► 9� Z$G l 631-61,1-J 5. CONTRACTOR'S NAME LICENSE STATE LItCkE/NSE 5rt%�1�� DD Ou S 11 rBBUUSIINESS V 1 IOU��6rl 7 NI.W16q—1 Class5i ADDRESS CONTRACTOR'S E-MAIL ADDRESS f3-S [>aL)tv 0✓ -4-- �— CITY STATE ZIP PHONE NO. �jT3 c f-T7,663 OFFICE USE ONLY PERMIT NO.,; •�1��'�L�� ( `off' PLAN CHECK NO. fCow900 wir POOL P/C FEE $ DRAINAGE P/C FEE $ Forms\Pool spa appl (rev3-04).xls