HomeMy WebLinkAboutS2024-0039 - Permit Application....... WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAIL NG ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK �,?L £ SP4 6 SS %Alrz- �CC w
Gri 3 ,J�Q� 1'72 E9 % ESTIMATED $VALUATION c7DIJ
SWIMMING POOL E� SPA POOL FENCING ❑ DRAINAGE,
Check AooroDriate box for Applicant
3. OWNER'ST FIRST
N ME Las
�-tn/
ADDRESS
-0g
OWNER'S E-MAIL ADDRESS
St � S r�
CITY STATE ZIP
f� �JeT TkGCA �2-&&3
PHONE NO.
4. ENGINEER'S AME LA T FIRST
LIC SE NO.
C1763-76
ADDRESS
ENGINEER'S E-MAIL ADDRESS
Cu If
CITY STATE ZIP
&4,JVL-- 7-
PHONE NO.
1 7AA306►oo
5. CONTRACTOR'S NAME ) (
BUSINESS LICENSE
STATE LICENSE[/ ry`
ADDRESS `, ppv�, /f �//-
J ll� I ��vM �!/f ��
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
Ll'PiAi, q26 (Al
PHONE NO.
71'1 VZ�57177
,Ct,
'E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
Pc-z0-u - a 6g Z--
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xis