HomeMy WebLinkAboutS2024-0045 - Permit Application{
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PLEASE PRINT OR TYPE
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK---1-71--l-9-1°c TRACT
2. DESCRIPTION OF WORK Sc' rtirh \l a
SWIMMING POOL( SPA'
Check Appropriate box for Applicant
ESTIMATED $ VALUATION :;95O cvc)
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
�W C):tif — 4, 7,1-6 � o
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTORS NAME
BUSINESS LICENSE
STATE LICENSE
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No. Class
DDRES
CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP
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OFFICE USE ONLY J
PERMIT NO. �V T ' p0qs�
PLAN CHECK NO.('?� Drja�
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool soa anol (rev3-04Lxls