HomeMy WebLinkAboutS2021-0137 - Permit Application (2)62021-01
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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r CITY OF NEWPORT BEACH
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BUILDING DIVISION v'
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1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION ^®
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL L�
ESTIMATED $ VALUATION
SPA ®/ POOL FENCING ❑
Check Appropriate box for Applicant
DRAINAGE ❑
3. OWNER'S NAME
LAST
FIRST
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ADDRESS
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OWNER'S E-MAIL ADDRESS
CITY
STATE
ge,4cq
ZIP
PHONE NO.
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4. ENGINEER'S NAME
LAST
FIRST
(CENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
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7topw 4 QLD /0 n la!y �s8 . C o s�
CITY
STATE
ZIP
PHONE NO.
A .v A "e<.41
90 Z f ® 7
(76'1 1 -,Yd' �)
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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ry
Pep PLf
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M
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY
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STATE
w-4
ZIPPHONE
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OFFICE USE ONLY 7 f
PERMIT NO. LS ��
PLAN CHECK NO. % Ci 1
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).x16 � � D f r