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HomeMy WebLinkAboutS2024-0155 - Permit ApplicationpV:Tc)ZZ — COS-7 WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION o i n CITY OF NEWPORT BEACH I'lIM'•' BUILDING DIVISION PLEASE PRINT OR TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) 1 o A- 6i54ovX LEGAL DESCRIPTION LOT BLOCK TRACT 2. DESCRIPTION OF WORK SWIMMING POOL ❑ SPA L: Check Aoorooriate box for ADDlicant _ ESTIMATED $ VALUATION Z I "Dad POOL FENCING ❑ DRAINAGE ❑ 3. OWNER'S NAME LAST FIRST ADDRESS OWNER'S E-MAIL ADDRESS JOG CITY STATE ZIP PHONE NO. �P 9n6o -71LF 43y 1/z� 4. ENGINEER'S NAME LAST FIRST cLrt LICENSE NO. - 1L-f 00r3 S ADDRESS `[11 ENGINEER'S E-MAIL ADDRESS C —L o l t S77,) CITY nn -- "" STATE ZIP A'`6,k t,t IM q PHONE NO. 1710,7306103 5. CONTRACTOR'S NAME BUSINESS LICENSE STATE LICENSE ©VT<t)OD2 CDj I �3137k No. CIJ�-? ADDRESS CONTRACTOR'S E-MAIL ADDRESS / �, \ �j 7 l kw' kl V r�7 CITY STATE ZIP �z677 PHONE NO. 1�9 �63.7913z� OFFICE USE ONLY PERMIT NO. PLAN CHECK NO. \ c 7-lc`�q `` I POOL PIC FEE $ DRAINAGE PIC FEE $ Forms\Pool spa appl (rev3-04).xls