HomeMy WebLinkAboutS2025-0075 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
PLEASE PRINT OR TYPE BUILDING DIVISION
1. PROJECT nnnRFcs mini
ESCRIPTI(lt\I
LOT
BLOCK
TRACT
2. DESCRIPTION OF WORK _� � 3 5QP- T�1 x' W Are A Yl r14�1n�
(QP`l � el e-L- 4-t 5,5(s� ESTIMATED $ VALUATION z10, 000
SWIMMING POOL ❑ SPA [ POOL FENCING �
DRAINAGE
Check Appropriate box for Applicant
3. OWNER'S NAME L
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ADDRESS -7 Co V\f1' (fCvACV
STATE Zip
6 CIA- 61u t
4. ENGINEER'S NAME LAST FIRST
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ADDRESS ENGINEER'S E-M
Z e \ �➢ Tcr S v. INN 2
fC�I,T,Y� STATE ZIP
5. CONTRACTOR'S NAME BUSINESS LIC
ADDRESS CONTRACTOR'S
J
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
PHONE NO.
LICENSE NO.
�60�1
NIL ADDRESS
HONE NO.
aENSSE
STATE LICENSE
zzNo. Q�%l\-k Class�l
--MAIL ADDRESS
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DRAINAGE P/C FEE $
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