HomeMy WebLinkAboutS2022-0154 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
ZO � (,� 1
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK �7� e� , J2, I�)c S.-
e- In''r-,LJ kx ct t 44 1-c✓ ESTIMATED $ VALUATION 1G' �co
SWIMMING POOL SPA ;Z' POOL FENCING ❑
Check Appropriate box for ADDlicant
DRAINAGE ❑
3. OWNER'S NAME
LAST
FIRST
L
c._
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
i
CA-
y Z6l a
7 Li- '' - mi l
4. ENGI EER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
® 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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0061 1 3
Class6
ADDRE2S
CONTRACTOR'S E-MAIL ADDRESS
1 _
S E
udc I
CITY
STATE
ZIP
PH NE NO.
,.
L
IZ'G�
- 0 6
OFFICE USE ONLY PERMIT NO. 20
2 2 -G I5N
PLAN CHECK NO. Pcic> L ` ` q 9
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls