HomeMy WebLinkAboutS2022-0145 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LCUI L UCOUMJI ' I IUIN J
LOT BLOCK
TRACT
2. DESCRIPTION OF WORK ��,.� y,> �� 1 (L.. C�nl Arl
ESTIMATED $ VALUATION�Ze)Oc.D
SWIMMING POOL SPA [ POOL FENCING ❑ DRAINAGE ❑
Check Anoronriate hnx fnr Annlirnn4
3.
OWNER'S NAME
LAST
FIRST
N
.
ADDRESS
OWNE,R' E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
4.
ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
a5.
CONTRACTOR'S NAME
BUSINESS LICENSE STATE LICENSE
-`
ADORE S
No. 077-1/E � Class653
CONTRACTOR'S E-MAIL ADDRESS
5
CITY
STATE
Zo P' \ NE NO. c M
/
OFFICE USE ONLY S PERMIT NO. Utz Z _ O' cis
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
FormslPool spa appl (rev3-04).xls
15-fit 191-702?
[) o22-Gt(