HomeMy WebLinkAboutS2024-0065 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
27CPI SfN"ORE-
LEGAL DESCRIPTION APN � 61+9 . I q Z,
LOT 2Z BLOCK TRACT 10I
2. DESCRIPTION OF WORK OO/JS-IR-IKi '� z' A* Emlw— ��"
Hag '` ESTIMATED $ VALUATIO47)S,q (o
SWIMMING POOL SPA POOL FENCING ❑ j;ZDRAINAGE El�wZ3. 0l5'ic
Check Appropriate box for Applicant
® 3. OWNER'S NAME
LAST
FIRST
sp" 05
ADDRESS
OWNER'S E-MAIL ADDRESS
27t47l B Sl DaS-
CITY
STATE
ZIP
PHONE NO.
NB
G4
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
=80� E tJ EE.
•.
'm1?D
0(05(A
ADDRESS
ENGINEER'S E-MAIL ADDRESS
?A I -iV 5'r• N AV
-tod d 10, • cn,v1
CITY
STATE
ZIP
PHME NO.
"A I M
011,
sty 430 (9100
5. C AETfJ" NAME
tjCANT
BUSINESS LICENSE
STATE LICENSE
H 110CONSTtAv Al o 0 —:POOL
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
sa►-ah`b1«{axic.2� mail, earl
CITY
STATE
ZIP
HONE .
�qq0
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
(^i U 26ZY, Saa b
pC2ozq-Oq y8
DRAINAGE P/C FEE $
Forms\Pool soa aoDl (rev3-04).xls