HomeMy WebLinkAboutS2021-0165 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH SM Z l Ol lQ s
BUILDING DIVISION
PLEASE PKIN I OR I TPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS) T (1)l
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING P00092
SPA 0
Check Appropriate box for Applicant
3�u V)u
ESTIMATED $ VALUATIOA, O4 000
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
P A4l
-1,\/V
ZIP
PHONE NO.
,CITY /STATE
4. ENGINEER'S NAME LAST FIRST
LICENSE NO. F�
C-101t�95V
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
1�. CONTRACTOR'S NAME
BUSINESS LICENSE
=STATELICENSEass cv
A(DDR'
CONTRACTOR'S E-MAIL AADDRESSt
l
G.. 1 LIS OJ (,C,
CITY STATE z4p
PAONE NO.
0Y 2,G
7/ - qd5- o'}s-d
,E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls