HomeMy WebLinkAboutS2022-0166 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH S2b (j1 �p�J
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
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SWIMMING POOL SPA
Check Appropriate box for Applicant
_ ESTIMATED$ VALUATION41oo,0co
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
ADDRESS -- -- -- ---- - - -
OWNER'S E-MAIL ADDRESS
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Ss
CITY STATE ZIP
PHONE NO.
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4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
Zb B t4 . To %I J ki
CITY STATE ZIP
PHONE NO.
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&A - N"b" UI
I ewk- to '; c
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
+ &-.AD 1Y1`
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
(041 ago.
OFFICE USE ONLY
PERMIT NO. L/�� eir,7 � 1�pQ�Q I/
PLAN CHECK NO. F1� , Z Z — \
POOL P/C FEE $y7
DRAINAGE P/C FEE $
\ Forms\Pool spa appl (rev3-04).xis