HomeMy WebLinkAboutS2024-0197 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
2 o q U o- E4�,or7c- i z
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK ()� � �� �� I tiic� .n tr-- E C7%,16r
ESTIMATED $ VALUATION / & DOJ
SWIMMING POOL SPA ❑ POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
�(
o r
ADDRESS
20 v 1A �P0i i
OWNER'S MAIL ADDRESS Y`y ��
I .
CITY STATE ZIP
PHONE NO.
�►Po��
7/43
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
lNo.&SZ-339
CIassS�
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
231 S I U PA6—
` CA,-J e 1 e6ovu cep� 6 ELF
CITY STATE ZIP
��� �n� r 9 z61L)
PHONE NO.
Toy �Sr h Ggf
Z USE ONLY
PERMIT NO. S vClCjl - Q 1 ct —7
PLAN CHECK NO. ��ZQl - 170 7
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls