HomeMy WebLinkAboutS2022-0122 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION Saba �" (�
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS) �p
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK nP y OXF [AjJ y
ESTIMATED $ VALUATION qeg e c)�
d
SWIMMING POOL SPA ❑ POOL FENCING ❑ DRAINAGE ❑
unecK Appropriate
pox for Applicant
3. OWNER'S NAME LAST FIRST
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¢ems
q ^ADDRESS ��„
OWNER'S E-MAIL ADDRESS
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V� n`'W�Bs
CITY STATE ZIP
PHONE NO.
ec A roo
W41 S-3�8 t�IS33
4. ENGINEER'S NAME LAST FIRST
LICENSE NO,
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY, STATE ZIP
PHONE
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ad P
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
No.L4'?r Lf'l'l Class C
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
:E USE ONLY
PERMIT NO. S Z, o I Z 'Z
PLAN CHECK NO. I V o Y -
POOL P/C FEE $ jS \ 3Oi %g�j V 6
5f31�z3
DRA)NAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls ^ZO-z-Z— — 0 27 7 7