HomeMy WebLinkAboutS2022-0049 - Permit Application'GQ
'$aP er WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
Jf �S
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION PC
LOT BLOCK TRACT�i
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATION �dC
SWIMMING POOL ❑ SPA�l POOL FENCING ❑ DRAINAGE ❑
Check Aw)rooriate box for Ann6rnnt
3. OWNER'S NAME
LAST
FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
7016t'
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5. CONTRACTOR'S NAME
WOb) CorawN{-' byLc-
BUSINESS LICENSE
STATE LICENSE
G
ADDRESS
No Class
Class
CONTRACTOR'S E-MAIL ADDRESS
317,5 r\W.wxy A
CITY
E 13DiL1DWIT4VNFir_D-C.wk
STATE
ZIP
PHONE N0.
Nq 00
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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