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HomeMy WebLinkAboutS2021-0054 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION CITY OF NEWPORT BEACH BUILDING DIVISION PLEASE PRINT OR TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) LEGAL DESCRIPTION LOT BLOCK TRACT 2. DESCRIPTION OF WORK V CVS l' ZCOL (iv�V? SPA ra`'l `� �> " � I Zt �r V,) n ,- �Y-"v�(� ESTIMATED $ VALUATION cf t SWIMMING POOL 0'- SPA ©- POOL FENCING 0-- DRAINAGE [J Check Appropriate box for Applicant Fl 3. OWNER'S NAME LAST FIRST If ADDRESS OWNER'S E-MAIL ADDRESS CITY STATE ZIP PHONE NO. @..j \ �i �"!`•�- °� ! CSC {",l p ��.�r l �.v\'a__.-�.7,iS 4 4. ENGINEER'S NAME LAST FIRST LICENSE NO. ADDRESS ENGINEER'S E-MAIL ADDRESS -T STATE ZIP PHONE NO. ('CITY ( i\r'A 0 le "01 5. CONTRACTOR'S NAME BUSINESS LICENSE STATE LICENSE No(Gl� Class ADDRESS CONTRACTOR'S E-MAIL ADDRESS (16 SL0�� 1 PL CITY STATE ZIP 2 Cl l� lyl ls5(�y [Ae PHONE NO. Z USE ONLY PERMIT NO. PLAN CHECK NO., POOL P/C FEE $ DRAINAGE P/C FEE $ Forms\Pool spa appl (rev3-04).x15