HomeMy WebLinkAboutS2025-0055 - Permit Application;?,� WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
'` CITY OF NEWPORT BEACH
' "' BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Alc' w
?,8 Q -;? Fri 4
ESTIMATED $ VALUA
SWIMMING POOL V SPA LRPOOL FENCING ❑
Check Appropriate box for Applicant
5 /dC, VOL?
DRAINAGE
0-3. OWNER'S NAME
LAST
FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
{<- /uF
CITY
STATE
ZIP
PHONE NO.
iv��✓�'r-. 7- lac «l
CA,
9L (YI7O
(yyC1)V3- 1;y 9y
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO 7y'pp3
ACljc1V /Z/17%lwe-r
26--pzi37--vc
ADDRESS
E-MAIL ADDRESS
IENGINEER'S
CITY
STATE
ZIP
HOENO.AIV/a
�tiinr
(-A-
92yP)l
r7y�1�3�-61�d
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
?FL A'/kL LVIA —rcl—
/697736,
/0'2774�, C-,J
No. Class
ADDRESS
CONTRACTOR'S ADDRESS
r /�
!I i~!, C7 e- X 32 y7
JE-MAIL
TO Al l L LvPr 0 t_-Y , C' 0 i"
CITY
STATE
ZIP
PHONE NO.
94
i9 519972 - v y.5b
CE USE ONLY
PERMIT NO.
PLAN CHECK NO.��
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls