HomeMy WebLinkAboutS2022-0172 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
^F° BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK �„ ,c. , e ��� c�_nr S ,,� o",-A� Lw.�2 c :r�—. - `iP r- L, (�
iQa_�� ?fJ�, `x� Ic. , i�. •� ���� �{< �1,,� s�,n��. ESTIMATED $ VALUATIOAirg [5s-)Ct
SWIMMING POOJ-� SPAS POOL FENCING ❑ DRAINAGE ❑
Check Amroariate box for Applicant
3. OWNER'S NAME LAST FIRST
L � k
ADDRES
OWNER'S E-MAIL ADDRESS
i 21,1— C, 0 Vti
CITY STATE ZIP
PHON O.
7Z-�2
`ig7,Z-�
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
E 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
l
NoC(• 6)6Class6
ADD8,ESS
CONTRACTOR'S E-MAIL ADDRESS
r 1
CITY STATE
ONE NO.
L�
qG
(OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
5zozz., 0172
PC zoz 2- 7.006
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls