HomeMy WebLinkAboutS2021-0282 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLtAJt PKIN I UK I YPt
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
t 10 ? q A K-; t Ilk L --A-/
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK rte' H,
ESTIMATED $ VALUATION S�;– Cp0 —
--- SWIMMING POOL SPA)( POOL FENCING ❑ DRAINAGE ❑
Check Annronriate box for Annlicant
3. OWNER'S NAME
LAST
FIRST
"(4 U-, I G rt
ADDRESS
OWNE 'S - "AIL DD
CITY
STATE
ZIP
PHONE NO.
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
(��
ADDRESS
E EER'SE-MAILADDRESS
CITY
STATE
ZIP
PHONE NO.
5. CONTRACTOR'S NAME
USINESS LICENSE
STATE LICENSE
✓
ONo.
Class
ADDRESS
CONTRACTOR'S E-MAILADDRESS
^–y
l�
-CITY
STATE
ZIP
PHONE NO.
;E USE ONLY
PERMIT NO.
PLAN CHECK NO
POOL P/C FEE $
DRAINAGE P/C FEE $
Farms\Pool spa appl (rev3-04).xls