HomeMy WebLinkAboutS2022-0167 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
3 00 M0 Av &� S7;k P— L.4-N&7
LEGAL DESCRIPTION
LOT BLOCK TRACT Z Z
2. DESCRIPTION OF WORK _COA3S-rIX2JC�?— /AJFj- M I T V 7'b6 C I I z %?,�
FD ()^-)bA-T7 8AJ ESTIMATED $ VALUATION 19 9s, GZ S' f
SWIMMING POOL ❑ SPA ❑
Check Annronriate box for Annlir-ant
POOL FENCING ❑ DRAINAGE ❑
❑ 3. OWNER'S NAME LAST
FIRST
SM 1 774
7-/ xf d-- AAf
ADDRESS
OWNER'S E-MAIL ADDRESS
/$ Z / SA �(i LBGJO ap L.�-�•I
CITY STATE
ZIP
PHONE NO.
JN J cam.
rj 2 (, ri 20
4. ENGINEER'S NAME LAST
FIRST LICENSE NO.
prlA Cor aSv��G )9cnzov
Pe-A-n-f &. j C "?!y
ADDRESS
ENGINEER'S E-MAIL ADDRESS
00 l (o / GA-S 7- --S Co dof
P. �cfr0 v G PHA. - &G-. cANt
CITY STATE
ZIP PHONE NO.
CAGvAJA- /J/GUI, C,4
�r7.75" Z
g2-(o7 7fNAdc?'7�'YClass
5. CONTRACTOR'S NAME
BUSINESS LICENSETE LICENSE
FLU/b A3AMIG2 POOLS
S
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
� 20 E . WA W U7- -8
su-r-&4- j b l E n c C� ,�na-i 1, ce
CITY STATE
ZIP NO.
7PHONE
FUGUZea-t,J G4�
92s� /9 �0C. g�
OFFICE USE ONLY
PERMIT NO. J �7i2
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
hormswool spa appl (rev3-04).xls