HomeMy WebLinkAboutS2024-0107 - Permit Application (3)WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
r Como rmill 1 vm I r rC
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
/927 Po/� CLJa//g5 Nerd/ �/ �j�0"l
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK FY&- i 1p P�l gAl SVti rc-S-,,F.eel,.Wr &
ESTIMATED $ VALUATION $ A�O
SWIMMING POOL ® SPA N POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
�7esl S���n
ADDRESS
OWNER'S E-MAIL ADDRESS
/gZ7 Po17k
CITY STATE ZIP
PHONE NO.
Me "l?- -, C4 9Z o
4. E GINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
® 5. CONTRACTOR'S NAME
BUSINESS
STATE LICENSE
IJ,,d4P/ Pool Plgj-ienn
/LICENSE
d p
No. 53 Class G
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
Goo t{/. F"a- " /qve—
ll(-ke F GaehL,1-2aMdgee/, G'or//
CITY STATE ZIP
PHONE NO.
OL^ e ca 9zAC6-
(ldq)z j -
OFFICE USE ONLY \7 zol
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls