HomeMy WebLinkAboutS2021-0029 - Permit Application'UK rUUL UUMUINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
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PLEASE PRINT OR TYPE v
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
--/52 3 SaI
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK �h
ESTIM fD
SWIMMING POOL ❑ SPA POOL FENCING ❑
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3. OWNER'S NAME
LAST
FIRST
ADDRESS -
-
OWNE E-MAIL ADDRESS:
8-23 5crol
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VC
CITY
ZIP
-7
PHONE NO.
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4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS.
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CITY
STATE
ZIP
PHONE NO.
21VVt
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92:LICENSE
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5. CONTRACTOR'S NAME
BUSINESS STATE LICENSE
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ADDRESS
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CONTRACTOR'S E-MAIL ADDRESS
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CITY
STATE
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
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POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls