HomeMy WebLinkAboutS2024-0121 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
'4 BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
12H VAX
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
L!r� ESTIMATED $ VALUATION
SWIMMING POOL ❑ SPA ❑ POOL FENCING ❑
Check Appropriate box for Annfleant
DRAINAGE ❑
Q'3. OWNER'S NAME LAST
iFIRSI
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ADDRESS
OWNER'S E ADDRESS
`-AIL
`'
CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
(A�t61-E-3o -§- gr.
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
S C;-vytiD— C,-� s ��� c�Y'�
BUSINESS LICENSE
STATE LICENSE
1No.III0Cf?3Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
je�F 0 c
CITY STATE ZIP
PHONE NO.
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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