HomeMy WebLinkAboutS2022-0110 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT _ . BLOCK PU'34 1/V:7- TRACT �l C
2. DESCRIPTION OF WORK ( e
{CL Ft -
SWIMMING POOL ❑
ESTIMATED $ VALUATION
SPA ❑ POOL FENCING ❑
Check Appropriate box for Applicant
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
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I�I L; /� n'C �
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
I
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
LGi L 1�Ut7"1v�L_ �'L<' IL' : �l�lo`, / �' �v.V i'ilJ'�
��Ll(li�+ ��."lLd-t.1�V1,✓I: .LCYY I
CITY STATE ZIP
PHONE NO.
OFFICE USE ONLY \ y
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls