HomeMy WebLinkAboutS2022-0163 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK V(5� 9�JOL- 2 G �� 'l <>-e Y,> ou `')-l'
ESTIMATED $ VALUATION
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SWIMMING POOL ��- SPA �� POOL FENCING ❑ DRAINAGE ®'
Check Appropriate box for Aodicant
3. OWNER'S NAME LAST FIRST
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ADDRESS
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OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PPHJONE NO.
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❑ 4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS
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ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
❑ 5. CONTRACTOR'S NAME
BUSINESS
STATE LICENSE
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LICENSE
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ADDRESS
ONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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PERMIT NO. G
PLAN CHECK NO. PC-zozZvw% 1866
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls