HomeMy WebLinkAboutS2021-0156 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION i
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
ILOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL ❑
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ESTIMATED $ VALUATION 3f%UcnE
SPA M POOL FENCING E; DRAINAGE.
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
3(o3 xlewPal
CITY STATE ZIP
PHONE NO.
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9Yg _ 364--o w
04. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
Briar) Potter Construction
1%37M7Class
ADDRE
35 Creek View Road
CONTRACTOR'S E-MAIL ADDRESS
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de GA 92679
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CITY STATE ZIP
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PHONE NO.
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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