HomeMy WebLinkAboutS2023-0057 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK OOL �
ESTIMATED $ VALUATION
SWIMMING POOL Q SPA [✓( POOL FENCING ❑ DRAINA
Check Appropriate box for Applicant
❑ 3. OWNER'S NAME LAST FIRST
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ADDRESS
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CITY STATE ZIP
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PHONE NO.
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4. ENGINEER'S NAME LAST FIRST
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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71 y � 30— bl l
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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3 9—y75
CE USE ONLY PERMIT NO. S Zo 2 A•U✓`s
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PLAN CHECK NO. PC V� ♦ 0665
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POOL P/C FEE $
DRAINAGE P/C FEE $
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