HomeMy WebLinkAboutS2023-0065 - Permit Application0iml
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
1 1-lo VoA-
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK VM fOo
SWIMMING POOL�(g5q �j SPAgj 0
Check ADDrODrlate box 1for Anolicant
A_h �-%i� ��US�,✓ Q�ect�C
ESTIMATED $ VALUATION 5 -5/ L-DU
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'SNAME LAST FIRST
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ADDRESS
( 'Po � L * s e' � r,
OWNE 'SE -MAIL ADDRESS
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CITY STATE ZIP
N6C(A4 qzj,6b
PHONE NO.
iY 7�2-(9Y3
rl 4. ENGINEER'S NAME LAST FIRST
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LICENSE NO.
ADDRESS
I19 . _�k4V A-
ENGINEER'S E-MAIL ADDRESS
�CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
LICENSE
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FSTATE
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Clas's
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
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PHONE NO.
1 (fq i) �Y-SY6b
:E USE ONLY Er Co
PERMIT NO. ZCSL3 �OZ `Z SZiSIJ� �W u4ft,3 O`-34
PLAN CHECK NO. Fc W-�z — 0 (J
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls