HomeMy WebLinkAboutS2022-0065 - Permit Application00,
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION S2U22-, Qo@
PLEASE PRINT OR TYPE ��v
1. PROJECT ADDRESS (NOT ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK jLe5'v44oJ t, -J )fA1 A Lcnu�/G
T eo rx LrD ' ESTIMATED $ VALUATION. �J l? S- LSb
SWIMMING POOL SPA POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
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ADDRESSNER'S
OWE-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
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4. 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 &L,(
' I `
P(AUW' A l; w.5
17Sr
No. -.7 I16 ClassCO
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
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1 71L-1. 14-23-017,-q
;E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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