HomeMy WebLinkAboutS2022-0243 - Permit Applicationa; frF, n WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK �l �S
`sA 1 l 6 -i 1 ESTIMATED $ VALUATI vOnD
SWIMMING POOL �] SPA LEI POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
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.
ADDRESS -
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP-7
ONE NO.
5. CONTRACTOR'S NAME 1 I
Ihl( C4,�� � onS'+�C "r � la. v�
BUSINESS LICENSE
I S001 rj (.Co e-/
STATE LICENSE
No. 5t, Class C-2
ADDRESS
Cllo y.ah -1
CONTRACTOR'S E-MAIL ADDRESS C-
�-
CITY STATE ZIP
5,z,10 4" Cv¢ G2`7o 1
PHONE NO.
1(7/l/ )D9 3-�C
:E USE ONLY
PERMIT NO.
PLAN CHECK NO. FG
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls