HomeMy WebLinkAboutX2022-1697 - Permit Application" P WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION, XAOaa-- tGci T
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE "-
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
410
LEGAL DESCRIPTION
LOT BLOCK L TRACT �� O
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATION
fear
II SWIMMING POOL '1-1f SPA POOL FENCING DRAINAGE ® II
l Check Anaronriate box for Aaalicant
3. OWNER'S NAME LAST FIRST
l
ADDRESS
OWNER'S E-MAIL ADDRESS
lb✓ 7
CITY STATE ZIP
PHONE NO.
CA q,�
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS ( ,
CITY STATE ZIP
PHONE NO.
Ayt/t/bg cal10
R6 L -7
® 5. CONTRACT R'S NAME
BUSINESS LICENSE
STATE LICENSE
CNo.
Z Class
ADDRESS 71
P,O
CONTRACTOR'S E-MAIL ADDRESS
akh � e—
CITY STATE ZIP
PHONE N' .
-45 t �TCh q.20�
'111 V-3-7�
,E USE ONLY,/ ' n ,
PERMIT NO. r G�(/Z Cj� 73
PLAN CHECK NO. 04
A Sq7 - 2esZ�Z' `
POOL P/C FEE $ vi u y
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls