HomeMy WebLinkAboutS2022-0086 - Permit ApplicationNY �� PpA
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PLEASE PRINT OR TYPE
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH G20e �(y/ (oA
BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
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t11 SWMTq-G POOL 0
SPA Ly
Check Appropriate box for Applicant
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ESTIMATED $ VALUATION On, 8 0 C) 5L
POOL FENCING ❑
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DRAINAGE
3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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57-3 - 3S a-br(o
4. ENGI EER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO,
Alie? 4>°r VK 04 92 fo 7
71Y-636 - 61"
5. CONTRACTOR'S NAME • fie n n 2 q
BUSINESS LICENSE
STATE LICENSE
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ADDRESS
CQNTRACTOR'S E-MAIL ADDRESS
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CITY / ll�STATE ZIP
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PHONE NO.
OFFICE USE ONLY S �/��� - L (7 U fZ L C7 Z Z %
PERMIT NO. L f% - �.1� L� % PZC9�(i - 0 U % 7
PLAN CHECK NO. o `" L Z?
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls v _ OC v�