HomeMy WebLinkAboutS2024-0076 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
9
CITY OF NEWPORT BEACH
BUILDING DIVISION _
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
M-1) SOh1ef.Sg�-
LOT
BLOCK
TRACT
2. DESCRIPTION OF WORK N('W 1 OO I l s�9'1 N
New F�repiT ESTIMATED$ VALUATION IS�O�O
SWIMMING POOLO SPA R- POOL FENCING ❑ DRAINAGE ❑
Cherk Annronriate box for Anolicant
3. OWNER'S NAME
LAST
FIRST
lH-Q
v
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
Ne,� orr
C1
C
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
la.l-.u-
T�
6 s
ADDRESS
ENGINEER'S E-MAIL ADDRESS
1.2ol N 7L)59-,iv�
Avg
CITY
STATE
ZIP
PHONE NO.
gR07
o- Woo
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
�
CR I QC�irs viG
�`��07
GS3
No. S�i7 ass
ADDRESS
CONTRACTOR'S E-MAIL
ADDRESS
21512 Am
Loi-y,
CITY
STATE
ZIP
PHONE NO.
Ljt�,�o\, N, JE!
C
�j2677
q4l-.2 aor
OFFICE USE ONLY 4
PERMIT NO. ,� � — 6U7 6
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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