HomeMy WebLinkAboutS2022-0185 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS) 14PM
314 e-VEWINC-7 CAAJ',logy CZ 9z�,(,7 a 0s2-z0-zl-7
LOT
BLOCK
TRACT )II
2. DESCRIPTION OF WORK CO�G'7 Cr 'PP L- 'j-SPA- / 3%a �>
ESTIMATED $ VALUATION
SWIMMING POOL SPA POOL FENCING ❑ DRAINAGE ❑
Check AoDrODriate box for Applicant
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
51iv0�J1^l--- ca-,.Jy�D.J
CITY STATE ZIP
PHONE NO.
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4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
PDoL, E N�2��� � C�+ e/Jt2f-'lvf
WC0
ADDRESS
ENGINEER'S E-MAIL ADDRESS
/yol n). 7-VsTl.J
ChriSbC' Olen co�
CITY STATE ZIP
PHONE NO.
A-NA-(-F-�lt-i cA- 976o7
7i 630 /6
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
lNo,'?2-�91? 7s—cla,ss
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
4901
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CITY STATE ZIP
PHONE NO. q yq q O c
oe-AN�-- C -+ 2gro
f % %
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
r
s �
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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