HomeMy WebLinkAboutS2023-0179 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
�LDy CITY OF NEWPORT BEAC
BUILDING DIVISION �'S�'"`k'
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
2 0 E^ I ,,, D,l Moy-
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL JL SPA
Check Anorooriate hnY fnr Onniicnnt
ESTIMATED $ VALUATION
POOL FENCING ❑
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
A+
II
Vl t W i ``,,,I,,
ADDRESS
I'Zo 5R
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
Cav-ohad %�.
PHONE NO.
q�7 -3U- �oSS
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
cky,(s R I eo leti baG�
7 �jb0
ADDRESS
ENGINEER'S E-MAIL ADDRESS
2(i us�',,,t -
),�d 005 hPzv�t
CITY }} STATE ZIP PHONE NO. l
C l 1 l "- b5 Q- C I0 V
5. CONTRACTOR'S NAME f BUSINESS LICENSE STATE LICENSE
No. to Rzo ClassG3
ADDRESS
37 j F Ldd/Zo gU
CONTRACTOR'S E-MAIL ADDRESS
"
Tk4Gi
r -J - l�, (Al
CITY STATE ZIP
11107
PHONE NO.
3 - S79 4 ?D
OFFICE USE ONLY Q�3p0gj 4l 02
PERMIT NO. 5?�Y� , o n of 238�7
PLAN CHECK NO. QG�%%�J •'GQ�D�
POOL P/C FEE $
DRAINAGE P/C FEE $
FormsWool spa appl (rev3-04).xls