HomeMy WebLinkAboutS2023-0198 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
3� CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1, PROJECT ADDRESS (NOT MAILING ADDRESS) 7-V �cAeo2q
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK �C Ges, 'CC WOk a"d Chi • RepLcja dy-min Ck1VPYs; CM
IAJ4+e( 11Vlf i11f • ESTIMATED $ VALUATION WI ZS'} • 00
SWIMMING POOL 0 SPA,[i POOL FENCING ❑ DRAINAGE ❑
Check ADDrouriate box for Anolicant
3. OWNER'S NAME LAST OSrVi FIRST C
ADDRESS 2-(0
OWNER'S E-MAIL ADDRESS
'Arm •619owt pwr tobK•GoIV)
CITY STATE CA . 2 ZIP
" T �
PHONE NO.
L711)"- T7 (q
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME At4M Smith F0015
BUSINESS LICENSE 7STATE
LICENSE w(
Nc(; l( Class
ADDRESS ZZ'I w, CArleti>ll AVe.
CONTRACTOR'S E-MAIL ADDRESS
�Aw-,el,t0wzP6 falIsmem s- covh
CITY /ll/GyliA� STATE CA. ZIP
PHONE NO.
OFFICE USE ONLY
PERMIT N0.
5zo?-3 ®'Q r
PLAN CHECK NO.
PC Zo 2'1 Z3L t
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls