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HomeMy WebLinkAboutS2022-0095 - Permit Applicatione `"�°"> WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION CITY OF NEWPORT BEACH F_ � BUILDING DIVISION 1. PROJECT ADDRESS (NOT MAILING ADDRESS) !4 �- ( S ;LAOK LEGAL DESCRIPTION LOT BLOCK TRACT 2. DESCRIPTION OF WORK 1�� o ESTIMATED $ VALUATION G16�_ SWIMMING POOL ❑� SPA ©' POOL FENCING ❑ Check Appropriate box for Applicant DRAINAGE ❑ 3. OWNER'S NAME LAST ' ^ tMl �V I FIRST -5alpwf fi paocl,, ADDRESS OWNER'S E-MAIL ADDRESS CITY Covtvqa Iq STATE ZIP `2 6 Z S PHONE NO. q(fl- 3t , ,63q 3 4. ENGINEER'S NAME d-e LAST FIRST LICENSE NO. 2U of v��jo� car C h rf s c �- ADDRESS ENGINEER'S E-MAIL ADDRESS CITY STATE ZIP PHONE NO. 7 fq - G 3G41Od 5. CONT�CT R'S BUSINESS LICENSE STATE LICENSE'RnCg�E 1 /NAME G l CO(� / l( �L �166Class No. Class ADDRESS CONTRACTOR'S E-MAIL ADDRESS I q 7a0 ve CITY STATE ZIP PHONE NO, OFFICE USE ONLY A �A _ O O PERMIT NO. PLAN CHECK NO. POOL PIC FEE $ 3q 6, DRAINAGE PIC FEE $ Forms\Pool spa appl (rev3-04).xis