HomeMy WebLinkAboutS2022-0155 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
" BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJ ECT�ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
IE
7) ESTIMATED $ VALUATION Giro
SWIMMING POOL SPA ❑ POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Aoolicant
3. OWNER'S NAME LAST FIRST
ONA-
AD RESS
I N o�-� i (/� E�-
OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
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CTCENSE NO.
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ADDRESS
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ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
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PHONE NO.
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5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICEN����
ADIDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
OFFICE USE ONLY
PERMIT NO.(„ 21�22 I07
C. SO '^
PLAN CHECK NO. 54 U, I�S
POOL P/C FEE $
DRAINAGE P/C FEE $
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