HomeMy WebLinkAboutS2022-0106 - Permit Applicationo P
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION �2CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS) r
1121` 4/ �/{ (D�Oq art o/c/vi VIA e;�,'
LEGAL DES RIPTI
LOT X7 v
, BLOCK TRACT
v
OF
ESTIMATED $ VALUATION / 5 iy
SWIMMING POOL ❑ SPA ak/ POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME
LAST
FIRST
ADDRESS
/
OWNER'S E-MAIL ADDRESS
CITY
C 0 r-o v-i V\- (� (
KA /-
STATE
ZIP
PHONE NO.
I(I1q - Z3 !63
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
, p
] �p
ADDRESS
ENGINEER'S E-MAIL ADDRES
CITY
STATE
ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
O (A o I
,2kreft&/llNo.
/jei
"'[ �
ADDRESS
c( O �(`I � r
v
CONTRACTOR'S E-MAIL ADDRESS
(%)l?,q (0, (0(,/ cD�S� Cr1�
I
CITY
STATE
ZIP
HONE NO. �?
:E USE ONLY
PERMIT NO. �.' � / � V Uw i
PLAN CHECK NO. l`IL /J'[J LIZ-111, Wt
POOL P/C FEE $ 1l
DRAINAGE P/C FEE $ 2, {4- �!
i
Forms\Pool spa appl (rev3-04).xls