HomeMy WebLinkAboutS2024-0068 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
/6 Z`�— G/14Ca r� L✓1
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
W O�-J PODL
3U/X ( S
P�VOAnc POLL
C-L/-en 3>e✓40
ESTIMATED $ VALUATION
4-f
42, (GC T` k' 1i �/GC
SWIMMING POOL SPA POOL FENCING ❑ DRAINAGE [�
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
/'« 1.` e-,/-
ADDRESS
OWNER'S E-MAIL ADDRESS
L b Z� LI n c-n C- ✓) t,vk
CITY STATE ZIP
PHONE NO.
NC.�P�iL—T f ee tk C97-666
<i-t� ��-- Lft��1
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
Le- CI-e- T�r2
6--65--G
ADDRESS
ENGINEER'S E-MAIL ADDRESS
t C/ N (v5�v �✓�
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
s�PfY� ��GLS
3O()<�3gC'A
No.1001611 ClassS3
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
I we,-- 12,2 �-
CITY STATE ZIP -
PHONE NO.
N i�s clY- I GZ660
CNI 06tiA
OFFICE USE ONLY
PERMIT NO. s5n p 0�1�
PLAN CHECK NO. ��y(J 4 (4
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool soa aool (rev3-04).x1s