HomeMy WebLinkAboutS2024-0012 - Permit Application (2)4?�w��AT WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
�` CITY OF NEWPORT BEACH
c"'""`"� BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Iy -i,,,j V ` a' .✓ P�, 6(-) -4�- lu
�. ESTIMATED $ VALUATION���
SWIMMING POOL SPA..' POOL FENCING ❑ DRAINAGE
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Ch k A ro riate box for Applicant
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3. OWNER'S NAME LAST FIRST
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ADDRESS OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST LICENSE NO.
ENGINEER'S E-MAIL ADDRESS
ADDR%ESS/�
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CITY STATE ZIP PHONE NO.
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5. CONTRACTOR'S NAME BUSINESS LICENSE STATE LICE?Nbff
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ADDRESS CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP
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PHONE NO.
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:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
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DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls