HomeMy WebLinkAboutS2022-0084 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDR 3S)
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LEGAL DESCRIPTION 0fi U G
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL E�( SPA`[o`
Check Appropriate box for Applicant
_ ESTIMATED $ VALUATION vc)e�
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAM\' LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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7 yoo �
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY ( STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
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BUSINESS LICENSE
STATE LICENSE
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No. Class«3
ADDRESS , \\
CONTRACTOR'S E-MAIL ADDRESS
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r
CITY STATE ZIP
G, �, w ,,-D CA-\
PHONE NO.
i
OFFICE USE ONLY Q
PERMIT NO.
PLAN CHECK NO. 161 S ( — Z67/ �
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls� l U�