HomeMy WebLinkAboutS2024-0022 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS) Ila-TLAr•yr
LEGAL DESCRIPTION J
LOT BLOCK
TRACT
2. ,DESCRIPTION OF WORK 12Ma rf r�txy(gy� �g (��� lqnil I CeAOrn-P-djjf)Mc
GLYAin werS ANGi wAt-,fl'nP fii ESTIMATED$ VALUATION 33coo&
SWIMMING POOL [/j SPA J� POOL FENCING ❑ DRAINAGE ❑
LAST DUYICGi YI
FIRST S+ Ive
FADDRESSME
0 7U(Ylb6rft, Pr,
OWNER'S -MAIL ADDRESSlitIA
rt 8 I -ea n 44KIC41n o6jmA i (• cow
( � STATE CA .
ZIPoi2(0(/(� PHON NO.
C�1gc'1} �i�-S - 3D�&O
R'S NAME LAST
FIRST LICENSE NO.
ENGINEER'S E-MAIL ADDRESS
STATE
ZIP PHONE NO.
TOR'S NAME A1on sm(iV) tests
BUSINESS LICENSE STATELICENSE
IUO(.
221 w %GI IC{O✓1 Ave,
CONTRACTOR'S E-MAIL ADDRESS(( Class'!,'
deniCl Ic�Z@q(ctnSYnrlh�Ya,(� Tory,
CITY O lcc4ygf STATE C,.
ZIP
PHONE NO.
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C714� 232 -�7aZ
:E USE ONLY
PERMIT NO. S/� 12� /0�21A to 00 Z2
PLAN CHECK NO. ��r WZ� Oats
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls