HomeMy WebLinkAboutS2024-0163 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION Dc'.0
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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ILEGAL DESCRIPTION ' II
LOT BLOCK TRACT
2. DESCRIPTION OF WORK LX�S�nq Do 1j SPA A, b,Q ftov�yd AgpnxS4 . r
ZMA 0ih 5i�Al AM ESTIMATED $ VALUATION
SWIMMING POOL SPA POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER' NAME LAST FIRST
ADDRESS (
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OWNER'S E-MAIL ADDRESS
► zM-5iq+ew►d�,eq�q-�
CITY STATE ZIP
ME��-bq�T ct2
PHONE NO.
c-Ac{- CPF U5
71-3CS-52g2
4. ENGINEER'S Nj�E
LAST FIRST
LICENSE NO.
I
ADDRESS
ENGINEER'S E-MAIL ADDRESS
I /
l2�� �. JS �IrJ n f�
�+
Y'<Ober�ol @t�Lxt%-Cs r1
CITY 1 STATE ZIP
PHONE NO.
1 J4- cp3o- G(Dc)
C-11*4- Z.�-1
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
&C-53
mrk1n v 1
No. 030 Class C
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE Z
b1�n z�U5
PHONE NO.
Zy3-5(00
;E USE ONLY / / I
PERMIT NO. - SZ�Z� — ` 6 3
PLAN CHECK NO. \ `'�'I — y S U
POOL P/C FEE $
i
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls