HomeMy WebLinkAboutP2022-0072 - Permit Application(I)
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WORKSHEET FOR POOL COMBINATION PERMIT APPLICATI:17ON
CITY OF NEWPORT BEACH
BUILDING DIVISION
rL=mac rmiNI UK iTFt:
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT v2 BLOCKg
2. DESCRIPTION OF WORK
SWIMMING POOL ❑ SPA
Check Appropriate box for Annrcan:
_ ESTIMATED $ VALUATION
POOL FENCING ❑
11i(YfiLi
DRAINAGE ❑
ENAME
LAST
7OWR'S
RESpS
OWNER'S E-MAIL ADDRESS
CIS
Y
STATE
�ZIIP/ PHONE NO.
4. ENGINEER'S NAME
LAST
FIRST LICENSE NO.
ADDRESS -
,rfiW
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
CO.
ZIP PHONE NO.
Itq,?I . 4i�*'—lr
r!
5. CONTRACTOR'S NAME
!
BUSINESS LICENSE STATE LICENSE
ADDRESS
No. Class
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
7USE
_0(21
NO.��
it A) L-1 L- .
POOL P/C FEE $
A q SD-
DRAINAGE P/C FEE $����
Formswom spa appi (reV3-04).xls