HomeMy WebLinkAboutS2023-0120 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS) /
A ,.) ZD (- I ,J V K Cam.✓
LOT
BLOCK
II0-ToI
2. DESCRIPTION OF WORK 1 V -t,- i
R Iy r 7 �� ESTIMATED $ VALUATION
SWIMMING POOL P9C SPA POOL FENCING DRAINAGE ❑
C f O3 c
Check Aonrooriate box for Analicant
3. OWNER'S NAME
LAST
FIRST
lei
qff
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY
STAIr
ZIP
PHONE NO.
k) `
�;PrCZ- �-27 -A S
Fj 4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
VOOZ
ADDRESS f
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
,�GJ�rrt
R
d�
7N' 63cl
5. CONTRACTOR'S NAME
B SINESS LICENSE
STATE LICENSE
�.�� l.� �.
'
No. 81)li 771 C
ADDRESS
47 w Cro, J v'� I
r1,1T
CONTRACTOR'S E-MAIL ADDRESS
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CITY
STATE
ZIP
PHONE NO.
'E USE ONLY
PERMIT NO.
PLAN CHECK NO.
r
POOL P/C FEE $
7
J
DRAINAGE P/C FEE $
FonslPool spa appl (rev3-04).xls
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