HomeMy WebLinkAboutS2021-0095 - Permit ApplicationS2021. ODIR
°�� r k WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
„,x •* CITY OF NEWPORT BEACH
PLEASE PRINT OR TYPE BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
11�nL u�OulllF' I JUN
LOT
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATION)
SWIMMING POOL SpA
POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Annlicant
4.
TRACT
STATE ZIP PHONE NO.
BUSINESS LICENSE STATE LICENSE
No. e W3 Class C'
CONTRACTOR'S E-MAIL ADDRESS
C�Yf�YQ,ScV��7'��
STATE ZIP PHONE NO.
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO. 9g� S• Zf»Z
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls