HomeMy WebLinkAboutS2022-0227 - Permit ApplicationLOT
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
(NOT MAILING ADDRESS)
BLOCK
2. DESCRIPTION OF WORK `J[Jd1 Spa c lr 4r�Aag(2 .I a-i-,,y �Qsu
ESTIMATED$ VALUATION
SWIMMING POOL SPA POOL FENCING ❑
Check Appropriate box for Annlicant
/2 0v C)Oltfl (Tay
---s+ab
DRAINAGE )�'
3. OWNER'S NAME LAST FIRST
S LCw,�
ADDRESS
OWNER'S E-MAIL ADDRESS
S(6(T�tviS � ✓kqj f ,CoW)
CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. COTRACTOR'S N ME
IJJII NI
�R rMIA
ADDRESS
BUSINESS LICENSE STATE LICENSE
`%y"f76Cl!Ylbl�'((
No. Cla��
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
OFFICE USE ONLY ?A41-0
PERMIT NO. SZoLZ- 0,2 '1
PLAN CHECK NO. �i L%/OZZ �Z^j2I
POOL P/C FEE $
DRAINAGE P/C FEE $
Xtzo�• 7--$7(�
rarms\•001 spa appl(rev3-04).xls