HomeMy WebLinkAboutS2022-0010 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
X BUILDING DIVISION
PLEASE PRINT OR TYPE -
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
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BLOCK
2. DESCRIPTION OF WORK S?A' (C) X9 °'
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SWIMMING POOL ❑ SPA Ly
Check Appropriate box for Applicant
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_ ESTIMATED $ VALUATION 'Ig -I O UO
POOL FENCING ❑ DRAINAGE n"�
3. OWNER'S NAME
LAST
FIRST
ADDRESS
OWNER'S E-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
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514
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CITY
STATE
CA-
ZIP
PHONE NO.
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5. CONTRACTOR'S NAME
BUSINESS LICENSE STATE LICENSE
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T"500 53LA 6`t No./W-76'41 Class53
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
63-5 ®v% 4-- 4—
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CITY
STATE
ZIP V
PHONE NO.
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:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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