HomeMy WebLinkAboutS2023-0208 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
a CAA-,445 -0 2kga- - CO k,�>T
LEGAL DESCRIPTION T LOT S BLOCK TRACT'
2. DESCRIPTION OF WORK
SWIMMING POOL ❑
SPA L f
Check Appropriate box for Applicant
5-I S
ESTIMATED $ VALUATION
POOL FENCING ❑
5, 000
DRAINAGE ❑
3. OWNER'S NAME
LAST
FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
Q-A- c4LA-
I LP "wzw 1 z 5 @ ry a% , tvM
CITY
STATE
ZIP
PHONE NO.
a Poe-,T
CA-
0� ae G74
pv� C-i- a33-1 8g
4. ENGINEER�'SSrAME
LAST
FIRST
LICENSE NO.
u
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5. C,ONnTR_pAjSCTOR'S NAME
AL4' CmM�
BUSINESS LICENSE
STATE LICENSE
C- z-• lNogP�10'
Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE N07il - •Z.{s-94q
/
/N,
�� Fwi
I L
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
S MIS - 0 Lots
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Forms\Pool spa appl (rev3-04).xls