HomeMy WebLinkAboutS2022-0012 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
(4)
CITY OF NEWPORT BEACH J'L�2'`�� {.
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF
vJ c1 W I'M N^ l
SWIMMING POOL )@ SPA
Check Appropriate box for Applicant
(7p 01 I SSR (Oy✓+
ESTIMATED $ VALUATION
POOL FENCING ❑
DRAINAGE ❑
3. OWNERS NAME �� FIRST
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ADDRESS
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OWNER'S E-MAIL ADDRESS
In�CdM>rtih�et,(w
CITY STATE ZIP
�IQvd �t� �LA0.�
PHONE NO.
10-111-Vill
4. ENGINEER'S NAME LAST FIRST
661 f'KtR-4 lac. — R6.1\ 1, 0, 0r
LICENSE NO.
D - M $
ADDRESS I iENGINEERS
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E-MAIL ADDRESS
,
CITY II.. STATE ZIP
e,IIM A
PHONE NO.
70 R
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
S 60i Y Ce o,+YN tr d K
{ �0$53
No. Class
ADDRESS
j L °l A, W$ S�
CONTRACTOR'S E-MAIL ADDRESS
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f r IT r4 a VI
CITYSTATE ZIP
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PHONE NO.
9q'q-�4 W
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (mv3-04).)ls