HomeMy WebLinkAboutS2022-0168 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
_ CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
a L/ m oG E s I nu c✓ �� s� c�� s a
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK cilJ L-,
Tvi-eRtd
SWIMMING POOL X, SPA ❑
Check Appropriate box for Applicant
ESTIMATED $ VALUATION
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
Gfi°D.a/�✓s� ,
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY /�EL✓�T �� %� G� STATE ZIP
PHONE N0..7 �
4. ENGINEER'S NAME LAST FIRST
$79-71 t--_ *s c✓ N�
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME , �c
CL141- 7 t 5
BUSINESS LICENSE
No. STATE LICENSE
Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
S? Od,.1 - C l 6 9
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls