HomeMy WebLinkAboutS2023-0190 - Permit ApplicationP
'4 WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
,.
10
CITY OF NEWPORT BEACH
4 __) .tl BUILD G DI ISI
PLEASE PRINT OR TYPE (�
1. PROJECT A $ (NOT MAILING ADDRESS)
�I 1
LEGAL DESC
LOT BLOCK TRACT U l SU
1
2. DESCRIPTION OF WORK IJC r- (> ti � �'' J.o { ` �> t t.� I% ;'.i: kr:,i f
ESTIMATED $ VALUATION, 6
SWIMMING POOL / SPA POOL FENCING DRAINAGE
Check Appropriate box for Applicant
3. OWNER'S NAME
LAST
FIRST
t.
7 C U
.. f d .)
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
/ C 7
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADORE
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
No. lgW-47Cj Class V
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
Z
PHONE NO.
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L. w
jl Ij� c� J.- - I r { .5 L
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
S2023 -OigO
"Q+GZoZ3 -2 -0Z
DRAINAGE P/C FEE $
Fo"slPool spa appl (rev3-04).xls