HomeMy WebLinkAboutS2023-0110 - Permit Applicationf
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS) /
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LEGAL DESCRIPTION
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2. DESCRIPTION OF WORK /�Zehto jEejjCjjt,4 O!Z /�J Spr/d R 4 f w ne
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k� cS�.- C�aC�%d i9avr p4 �Oh�^• ESTIMATED $ VALUATION SzS000 d
SWIMMING POOL SPA,M POOL FENCING ❑ DRAINAGE
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3. OWNER'S NAME AST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME LAST FIRST LICENSE NO.
ADDRESS ENGINEER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE STATE LICENSE
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No.(DZby28 Class (=
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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;E USE ONLY
PERMIT NO. ,00�3_ 0110
PLAN CHECK NO. Pc Z OZ 3 — 1273
POOL P/C FEE $
DRAINAGE P/C FEE $
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