HomeMy WebLinkAboutS2022-0079 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
rLr AZ,r MIN 1 UM 1 irC
1. PROJE`CT/ ADDRESS (NOT MAILING ADDRESS)
a �/ ( 0) 0 LoLW10.A 1 Lz-
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK��
�j �/ ESTIMATED$ VALUATION 76,o�o
SWIMMING POOL L� SPA ER/ POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'SNAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
V(, J�luv"a��e
CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
J 0 9'L—
lNo9103S
Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
U tAI [3 `*,rco r to S�
brAc000fcon c—,) aAkao')
CITY STATE ZIP
PHONE NO.
:E USE ONLY
PERMIT NO. S 2022"1}U-7GI
PLAN CHECK NO. om
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls