HomeMy WebLinkAboutS2024-0149 - Permit Application°k WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
7Sx_F9 A 911. Y 16711//0 0
1. PROJECT 1 ))ADDRESS ,JAILING DDREss)�15�0 L
LEGAL DESCIJRIPTI/IJION JJJ
LOT BLOCK TRACT
2. DESCRIPTION OF WORK _1FWL 36 X i j cv q'Z- jr ►Pri > e r2SPI u,i,,�,4y w c—
Yeyyw 0 o k Z ?CO � :5a ,'1III, ,&GS + -e l << ESTIMATED $ VALUATION
SWIMMING POOL 9 SPA e 190*00 SPOOL FENCING ❑
Check Appropriate box for Applicant
t4 4 (000
DRAINAGE LZ0 '
3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
61 ) � I1 6 T (�j✓I 5'f e
CITY STATE ZIP
PHONE NO.
P13 Ceg- G(7,660
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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�5 ? 053`A61
INJO0104CIass5
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
�N P✓ CAULG Pl,
CITY STATE ZIP
PHONE NO.
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OFFICE USE ONLY /�
PERMIT NO.��- (� I 1 L CI ZJy J
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool soa aool (rev3-041.xls