HomeMy WebLinkAboutS2022-0001 - Permit ApplicationSM? -z 1000
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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� y CITY OF NEWPORT BEACH
PLEASE
LEASE PRINT OR TYPE BUILDING DIVISION , C
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I. PROJECT ADDRESS (No ILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK r --.f 51 TRnrT
01
v I 1 1 1,vf Y U UJAEgVAATED $ VALUATION/ ,
SWIMMING POOL SPA POOL FENCING ❑ DRAINAGE ❑
Check AoorOoriate box for Aoolicant
3. OWNER'S NAME LAST FIRST
(�
7� L�
ADDRESS
OWNER'S E-MAIL ADDRESS
!I
Q to S
CITY STATE ZIP
PHONE NO.
bi �ev) q? 6 L!
- 6
4. ENGIN
ER'S NAME LAST FIRST
LICENSE NO.
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s�
Q� G�IJ
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
OU� C 6\1
No. 3 Class
ADDRESS
CUNTRACTOR'a&MAII ADDRESS
!7oII Ne A L4 -5vr
a1P\It
CITY STATE ZIP
1PHONE/N .
lv 1 -C'[�` "lp i
O
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
r,5— �1 f
POOL P/C FEE $ f
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls