HomeMy WebLinkAboutS2021-0266 - Permit ApplicationPLEASE PRINT OR TYPE
1. PROJECT ADDRESS
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
ADDRESS)
ILEGAL DESCRIPI
LOT17 a ! BLOCK TRACT
2. DESCRIPTION OF WORK IjcAl o CC CA t C w-r 5 f5 rh o
�o� Sys ESTIMATED $ VALUATION -t' 600
SWIMMING POOL SPA 2"� POOL FENCING ❑ , DRAINAGE
f+M....L A..----.: r4r 4.r.. Fr. A....lir�r.4 -/ I�:l 11/ � I 6✓ �', A''�`' eW`` / �`'/.I l.� -• �'� e
❑ 3.
OWNER'S NAME
G?S
LAST
r�r"I
FIRS
ADDRESS
WNER'S E-MAIL ADDRESS
rvarllOvloy
CITY
STATE
ZIP
PHONE NO.
4.
ENGINEER'S NAME
LAST
i FIRST
LICENSE NO.
ADDRESS
ENG EER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5.
CO TRACTOR'S NAME
NA a
kf)ool
BUSINESS LICENSE
STATE LICENSE
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
Z USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls