HomeMy WebLinkAboutS2022-0015 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
v CITY OF NEWPORT BEACH _
PLEASE PRINT OR TYP�
" BUILDING DIVISION
VKUJtU I AUUKtSS (NOT MAILING ADDRESS)
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LOT
2. DESCRIPTION OF WORK
BLOCK
.,POOL 5'p> wf- N
ESTIMATED $ VALUA
SWIMMING POOL ED -'SPA Ly/ POOL FENCING ❑
Check Aonronriate box for Aoolirant
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
SlU KI,v65 ROAD
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CITY STATE ZIP
PHONE NO.
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(9y5)Z30 --7L/
4. ENGINEER'S NAME LAST FIRST
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LICENSE NO.
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ADDRESS
Ave-7cIMS-13C
NGINEER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
4n/CASC�r�I�
(0�0 CP 100
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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910-1325 CS-
No. Class
ADDRESS �i F,,!
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CONTRACTOR'S E-MAIL ADDRESS �) �%
CITY STATE ZIPPHONE
NO.
CA 92 7 9 %
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:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
Ulu
POOL P/C FEE $
DRAINAGE P/C FEE $
rormswool spa apps (rev3-04).xls
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