HomeMy WebLinkAboutS2022-0237 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
F
CITY OF NEWPORT BEACH
BUILDING DIVISION J
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATION /'rJZ�
fZX30
SWIMMING POOL SPA j POOL FENCING ❑ DRAINAGE ❑
Check Aaaronriate box for Anniir_ant
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
n A
C STATE ZIP
PHONE NO.
2
❑ 4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. C TRACT0 'S NAME
BUSINESS LICENSE
STATE LICENSE
No. �' S'�%'9 C I a s
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
OFFICE USE ONLY
PERMIT NO,
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls