HomeMy WebLinkAboutS2022-0250 - Permit Application}} to rr
1
PLEASE PRINT OR TYPE
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT
2. DESCRIPTION OF WORK
OMF
SWIMMING POOL K' SPA ❑
Check Appropriate box for Applicant
TRACT
ESTIMATED $ VALUATION e�—o<
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
�/�
! C I Av V 7:W4 A�?v1/
ADDRESS
OWNER'S E-MAIL ADDRESS
�g
9 b' `��� TLv�✓
/�iG�z-L7G .�6 j ®k,nlc'�, C
CITY STATE ZIP
kc-Njp -� 614_ 1?04-la 3
PHONE NO.
4. ENGINEER'S NAME LAST FIRST
/y(4*-o e7,
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
12o1 �,! r��) ,��°
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
2 /J
lNo./Pl/W p)
Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
/ ? Y
Z?41A, C • C06111
CITY STATE ZIP
PC w�2&o cl I',fd• 92S-or
PHONE NO.
W.�??O /9gZ-
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
m
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls