HomeMy WebLinkAboutS2021-0276 - Permit Application (2)WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
(o BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK �J e `� ��r If /7f) ' �✓ 4 3Z rI VJK eiq bC� �t"c✓Vl
(GAS 4, Wf ,-Fl L
wr Q 7- ESTIMATED $ VALUATION V
SWIMMING POOL ❑ SPA I�i-' POOL FENCING ❑ DRAINAGE [V/
Check Appropriate box for Applicant
3. OWNER'S NAME FIRST
gLAST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
\QFC:j�- Z6
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
1'7,�f P- —Tv 54, A. -e-
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5.NAME
BUSINESS LIICEYNSE
STATE LICENSE
—CO�NNT�RACTOR'S
50uL->3 e 161
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No.1�V4� Classl/2
ADDRESS
CONTRACTORS E-MAIL ADDRESS
-7
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CITYj�1/'�i✓
CITY STATE ZIPPHONE
NO.
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,E USE ONLY
PERMIT NO. 52o2(•DZ1c� X202 �' 0 r J
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls