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HomeMy WebLinkAboutS2023-0142 - Permit Application (3)I pk) WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION CITY OF NEWPORT BEACH PLEASE PRINT OR TYPE BUILDING DIVISION 1. PROJECT ADDRESS (NOT MAILING ADDRESS) tn'tl,�- LOT BLOCK TRACT 2. DESCRIPTION OF WORK _W Ilj �OL, i a �j'3G� �uZ p �-- It A 0l t ^5 ESTIMATED $ VALUATION _y[S10000 SWIMMING POOL LD SPA El POOL FENCING ❑ DRAINAGE ©� Check box for tw-. v Iz \,/j K) .T? 5 'G & 4. ENGINEER'S NAME LAST Z-,,-- C %, e,,- _T�-'r7f7 -7 0, CITY STA 1''Y'5f KtIWt CA- 61 �-d t.9''( Pp v1- S -e v /aiz t�-- - -- :E USE ONLY PERMIT NO. PLAN CHECK NO. POOL P/C FEE $ ZIP PHONE NO. '4, i q c, PHONE NO. -5:�l �50-6I00 STATE LICENSE STATE ZIP PHONE NO. CIA— S7os3 �viy�...,E?o�,'�i�dri11 ,�,y�otty DRAINAGE P/C FEE $ Forms\Pool spa appl (rev3-04).xls