HomeMy WebLinkAboutS2022-0182 - Permit Applicationn rr
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
i CITY OF NEWPORT BEACH
9 BUILDING DIVISION
PLEASE PRIN I UK IT rt
1. PROJECT ADDRESS (NOT MAILING ADDRESS) I/
LEGAL DESCRIPTION
LOT BLOCK 7 TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL SPA
Check Appropriate box for ADDlicant
S c� qq(
_ ESTIMATED $ VALUATION
POOL FENCING ❑
DRAINAGE X,
3. OWNER'S NAME LAST FIRST
2
Cv x, VJc CAVE
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY I STATE ZIP
PHONE NO.
N ) o
4. ENGINEER'S NAMV LAST FIRST
LICENSE NO.
ADDRESS
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ENGINEER'S E-MAIL ADDRESS
-1
I -
o , t� e
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME _
2
BUSINESS LICENSE
STAT LI ENSE S3
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No. Class
ADORES
CONTRACTOR'S E-MAIL ADDRESS (��/ L17r/
CITY STATE ZIP
PHONE NO.
CE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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