HomeMy WebLinkAboutS2021-0220 - Permit Application��wNuk� WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
BUILDING DIVISION
1 PROJECT ADDRESS(�pNMAILINGADDRESS) �' `�
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LOT BterCK �� % p J —vrRACT
2. DESCRIPTION OF
SWIMMING POOL SPA'
Check Appropriate box for Applicant
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162ke %4 �5
$ VALUATION - 4-20 W)
POOL FENCING ❑ DRAINAGE ❑
3. OWN R'S NAME
c LAST FIRST
ADDRESS
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OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
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PHONE NO.
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4. ENGI EE 'S NAME LAST FIRST
LICENSE NO,
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ADDRESS
J411 Al, 6cc�6�1 n-
ENGINEER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
904,
171q
5. COC � NAME S
BUSINESS LICENSE
TAT�L `Y E,LICEENSE L'
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No.
ADDRESSCONTRACTOR'S
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E-MAIL ADDRESS
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CITY STATE ZIP
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PHONE NO.
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CE USE ONLY
PERMIT NO. �D Y
PLAN CHECK NO. Z2b�- ZU�� R� �0�0
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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