HomeMy WebLinkAboutS2022-0103 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
16I S Gt✓,/cCL1v LvA
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK bold - t L
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�� > {^ �Cl p � l ESTIMATED $ VALUATION
SWIMMING POOL SPA POOL FENCING ❑ DRAINAGE 0-
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
OWNER'S E-MAIL ADDRESS
/ADDRESS
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CITY STATE ZIP
PHONE NO.
AJ P5 ciz(�,(,u
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4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
( zc i Q CA 41, I/L
CITY STATE ZIP
PHONE NO.
4v-x a I^gA vh C t�1— crz
116 30 - 61 1
5. CONTRACTOR'S NAME
BUSINESS LICENSEq
STATE LICENSE
CONTRACTOR'S E-MAIL ADDRESS
�7ADDRESS
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CITY STATE ZIP
PHONE NO.
06
Pr-
OFFICE USE ONLY �O �Z- �7 I
PERMIT NO. S %C oto �Z-OUrjc-,
PLAN CHECK NO.
POOL PIC FEE $
DRAINAGE PIC FEE $
Forms\Pool spa appl (rev3-04).xls — CJ
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