HomeMy WebLinkAboutS2021-0043 - Permit ApplicationuWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
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1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK e �/V GL r� tr �b'B -. r�
P c:� h ckr1,%3 ESTIMATED $ VALUATION
SWIMMING POOL ❑ SPA ❑ POOL FENCING ❑ DRAINAGE ❑
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3. OWNER'S NAME
LAST FIRRU
ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY
STATE ZIP
PHONE NO.
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11 G 7h
4. NGINEER'S NAME
LAST FIRST
LICENSE NO.
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ADDRESS
ENGINE R'S: ,M1 14 ADDRESS
7
CITY
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STATE ZIP
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PHONE NO.
1 1*1].2Z�;,-a1
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111.
NAME
BUSINESS LICENSE
ST§T LI SE S
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/55.. jCONTRACT7OR'S
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No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY
LIS"
STATE ZIP
]PH -UNE NO.
!jz Z y�-6 171
OFFICE USE ONLY
PERMIT NO.
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PLAN CHECK NO.
U35q 2( ZJ
POOL P/C FEE $
DRAINAGE PIC FEE $
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