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X2022-0350 - Permit Application
FQ�xwP°"r� WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION 0U-6QCrDC✓l) ,Pj e CITY OF NEWPORT BEACH `0 twaxM' BUILDING DIVISION PLEASE PRINT OR TYPE 1. PROJECT ADDRESS (NOT MAILING ADDRESS) 1b Ptl 00row ©ec / r- T c) LEGAL DESCRIPTION LOT BLOCK TRACT 2. DESCRIPTION OF WORK lam/ ii/Ifaf,"c (M On 1 �,Op ESTIMATED $ VALUATION 4 i D, D Dy SWIMMING POOL SPA D�r POOL FENCING ❑ DRAINAGE ❑ Check Appropriate box for Applicant 3. OWNER'S NAME LAST FIRST ADDRESS OWNER'S E-MAIL ADDRESS CITY STATE ZIP PHONE NO. 4. ENGINEER'S NAME LAST FIRST LICENSE NO. ADDRESS ENGINEER'S E-MAIL ADDRESS CITY STATE ZIP PHONE NO. 5. CONTRACTOR'S NAME BUSINESS LICENSE,STATE LICENSE E� No. %�`J*3lGlass ADDRESS CONTRACTOR'S E-MAIf ADDRESS CITY STATE ZIP PHONE NO. :E USE ONLY PERMIT NO. PLAN CHECK NO. POOL P/C FEE $ DRAINAGE P/C FEE $ Forms\Pool spa appl (rev3-04).xls e?r» rte,