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Home My WebLink AboutS2021-0165 - Permit Application (2)O Nv'r�R T WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION ' a CITY OF NEWPORT BEACH SMZI pIIQS IIIYIIMHT ` BUILDING DIVISION PLEASE PRINT OR TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) LEGAL DESCRIPTION LOT BLOCK TRACT 2. DESCRIPTION OF WORK SWIMMING POOL -\Q SPA[. j Check ADDronriate box for Annlicant _ ESTIMATED $ VALUATION'A"'O, oo0 POOL FENCING ❑ DRAINAGE ❑ 3. OWNER'S NAME LAST FIRST S2r- S -c—" ADDRESS OWNER'S E-MAIL ADDRESS PI'lly A4l CITY ZIP PHONE NO. /STATE 4. ENGINEER'S NAME LAST FIRST LICENSE NO. p G-U1��V ADDRESS ENGINEER'S E-MAIL ADDRESS CITY STATE ZIP PHONE NO. 1�. CONTRACTOR'S NAME BUSINESS LICENSE STATE LICENSE \ \S V�' No. q -}j) �`� Class C54 ADDRCONTRACTOR'S E-MAIL ADDRESSSTATE tocVITY'Allf- P NE NO. ?- - ch 1 7/ - W ©�S� :E USE ONLY PERMIT NO. PLAN CHECK NO. POOL P/C FEE $ DRAINAGE P/C FEE $ Forms\Pool spa appl (rev3-04).xls Sett' OWO ML-` om