HomeMy WebLinkAboutS2022-0156 - Permit Application0
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE _
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
�D \ --1 IC4 c-r�,cj V�
LE_GA_I_DZSGalPTION �Gh�
BLOCK SQ)�
TRACT C'O Cf(
2. DESCRIPTION OF WORK � 'CtZ i I ) N(- -,-,zi}' CA
�Dc� � l- ESTIMATED $ VALUATION
SWIMMING POOL ❑ SPA\�n POOL FENCING ❑
Check Appropriate box for Applicant
DRAINAGE ❑
❑ 3. OWNER'S NAME
LAST
FIRST
ADDRESS
7 1� ,
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
NO.
�(—:- l_,� J,
Q�-R
�D- ('�)
gPHONE
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
S. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
ADDRESS ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
(�
- 1
C TY
STATE
ZIP
PHONE NO.
OFFICE USE ONLY
PERMIT NO.
e6
PCZ-0Z-Z _
PLAN CHECK NO.
POOL P/C FEE
o�
$
DRAINAGE P/C FEE $
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Forms\Pool spa appl (rev3-04).xis