HomeMy WebLinkAboutS2024-0051 - Permit Application`` ";" k> WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
IZ16 sus,.
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK %%v Sir 7rtv,�lg 1313GL
S ESTIMATED $ VALUATION N 62 LQ
I
SWIMMING POOL ❑ SPA POOL FENCING ❑ DRAINAGE
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
1716 Kqo< Ln I
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CITY STATE ZIP
PHONE NO.
` gT660
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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714co3
ADDRESS
ENGINEER'S E-MAIL ADDRESS
I w I 1J Ist� n
CITY STATE ZIP
PHONE NO.
Aackim CA qUo-7
1 71y GEC-61oo
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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lNo.J167M5 ClassL53
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
po (�OK UM 37
CITY STATE ZIP
PHONE NO.
�.44G ka Cn- 427ciq
1 71q. Zqi 760
OFFICE USE ONLY (�z�j�{ (� 1 bH
PERMIT NO. SZ p-LA - W5 I fLZa 4 — 0bc(8
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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