HomeMy WebLinkAboutS2025-0115 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
3 i
`J CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS) / Q
Zco PO ✓ % (� IP 1'5 i o G r` / �Ph/ o i H Ueeaa� Ge q2 c6 0
LEGAL 15ESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK �U� �GHe �v� Z 50fr SAW
ESTIMATED $ VALUATION U O b
SWIMMING POOL � SPA POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Annlicant
3. OWNER'S NAME
LAST
FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
18v. CONTRACTOR'S NAME
Sri, ; �I �a� S
BUSINESS LICENSE
STATE LICENSE
No. Class
ADDRESS
2 2% w Cc. r��o�
CITY
Drums 5 e Cs
o�aK e C�
SIAIE
CONTRACTOR'S E-MAIL ADDRESS
(�'�. LaAe--*erp�(u�
ZIP PHONE NO.
V-Czr- al Y3
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE PIC FEE $
3407-5-oi150
?C 2oz. 5 - o 3 \'Z
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