HomeMy WebLinkAboutS2022-0240 - Permit Application417(1�
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION �40a� -kayo� CITY OF NEWPORT BEACH
¢ BUILDING DIVISION
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1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL.X SPA ❑
Check Appropriate box for Applicant
ESTIMATED $ VALUATION `%', 1200
POOL FENCING P� DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY �GZL STATE ZIP
PHONE NO.
'If CIA
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME coner- ZZf P✓
BUSINESS LICENSE
STATE LICENSE
No. �Cx�F Class
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 $
FormsWool spa appl (rev3-04).xls