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HomeMy WebLinkAboutS2021-0064 - Permit Application"R> - WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION - CITY OF NEWPORT BEACH BUILDING DIVISION PLEASE PRINT OR TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) (UU <yM✓v�i>�.f G� LEGAL DESCRIPTION LOT BLOCK TRACT 2. DESCRIPTION OF WORK \NJ illi L% GI i r �,n-� ('"AA\ r .n I 0 SWIMMING POOL ©'-( SPA Check Appropriate box for Applicant _ ESTIMATED $ VALUATION POOL FENCING ❑ DRAINAGE <®r - 3. OWNER'S NAME LAST FIRST ADDRESS OWNER'S E-MAIL ADDRESS I (oo omvo-eVa�`� CITY STATE ZIP PHONE NO. 4. ENGINEER'S NAME LAST FIRST LICENSE NO. ( �' �' I (A)U-3 v ADDRESS ENGINEER'S E-MAIL ADDRESS CITY STATE ZIP� PHONE/NO. INA vo 1 50 5. CONTRACTOR'S NAME BUSINESS LICENSE STATE LICENSE _ n //fi�rr ;U \/�)W� .5U(} a y / � No. y� ^if lass. ADDRESS CONTRACTOR'S E-MAIL ADDRESS r r J t ?I 0!t,eLl CITY STATE ZIP flu PHONE NO. OFFICE USE ONLY PERMIT NO. PLAN CHECK NO. POOL P/C FEE $ DRAINAGE P/C FEE $ Forms\Pool spa appl (rev3-04).xls