HomeMy WebLinkAboutS2022-0196 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
F �,n
CITY OF NEWPORT BEACH
BUILDING DIVISION
r LCHJt MIN I UK I T1't
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION y 702 -1 S' 1 - n 7
LOT BLOCK TRACT t 0 %
2. DESCRIPTION OF WORK 'Vot( �ql U-CM0 (44 � fe hbtj,
ESTIMATED $ VALUATION
SWIMMING POOL J"' SPA ❑ POOL FENCING ❑
Check Appropriate box for ADDlicant
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
S �,1 CA cf -, c Ito
CITY STATE ZIP
W C fj-- 9261 ?
PHONE NO,
q�Y-VK3 - 5-20
❑ 4. ENGINEER'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
Ca l f M 1h 0
No. 76 class C5
ADDRESS vCONTRACTOR'S
23 420 6fak �Ia2a #lo
E-MAIL ADDRESS
CITY STATE ZIP
�5-7
PHONE NO.
2
lq K 32 y
;E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
34,v?�, DICIy m, 01�1
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls