HomeMy WebLinkAboutS2022-0255 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
rLCAJE rKIN I UK TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT ;-2 - 1 f{'+ BLOCK TRACT 7 Z
2. DESCRIPTION OF WORK [�ci juc ci,yos jj& 5pft� y aij
A}f'3 Fly E / T ,4/2/J P/�!#%NHS /2 C'X/S//E STIMATED $ VALUATION 4�e,006
SWIMMING POOL AA.' SPA POOL FENCING ❑ DRAINAGE Ir
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
ADDRESS
W � g l 0't
O ER'S E-MAIL ADDRESS
S Pi/2 ( 212@ . • 6(�
ITTY STATE ZIP
�✓G✓)0l)r-' l CULT �'� �2GS
PHONE NO.
'/c/ >�2J
4. ENGINEER'S NAME LAST FIRST
NO I En /
LIC NSE NO.
5 �
nc -
076
ADDRESS u
�2- N �USI ►� �U�
ENGINEER'S E-MAIL ADDRESS
4' te�c>-t (?o •Carts
CITY STATE ZIP
A0k)46p) C/ %7�a
ONENO.
jr,71 f 63aO
5. CONTRACTOR'S NAME
US(/}N �0.
BUSINESS LICENSE
STATE LICENSE A-� 0
C]yc-Z7
NST/ueT(oN
RT3tuf� �l�i 3
�(94(��
No. Ciass
ADDRESS
j CS60 5uP6✓Lrol�' �Ut 5utT-c53
CONTRACTOR'S E-MAIL ADDRESS
�j ✓k-ce&f(Jsc o 1 •�a�,
CITY STATE ZIP
C,5Trk Mc-sA C!�- 926z7
PHONENO.
94�5/g- 33Ss—
OFFICE USE ONLY
PERMIT NO. S`)4]i2� b`�� �i 2p'lZ�o3gJ0
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
rormswm spa appl (revs-U4).xls
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