HomeMy WebLinkAboutS2021-0085 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION S2 Ovi -(�O
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
(01
1
LOT
2. DESCRIPTION OF
BLOCK rq I Z-�
SWIMMING POOL ❑ SPA ❑
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_ ESTIMATED $ VALUATION
POOL FENCING ❑
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
j olr [✓'
ADDRESS
OWNER'S E-MAIL ADDRESS
1-..
CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
3�5 rz -
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
2
( q6� — J7J
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
OFFICE USE ONLYQO�
PERMIT NO. `
/�PLAN CHECK NO. A
POOL P/C FEE $ Vr/ `��
DRAINAGE P/C FEE $/o"
Forms\Pool spa appl (rev3-04).xls