HomeMy WebLinkAboutS2022-0051 - Permit Application,4� "'9 WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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°r,EfFo CITY OF NEWPORT BEACH
BUILDING DIVISION S®Z Z Ube 9
PI FARE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LI CW44, .Sf
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK /�pAr" VW AV01 � � aril . ��o [�4C LED 4�jCtT OVA/
Af� C4VC�'s� ESTIMATED $ VALUATION I f
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SWIMMING POOL SPA Rk POOL FENCING ❑ DRAINAGE ❑
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3. OWNER'S NAME LAST FIRST
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ADDRESSOWNER'S
E-MAIL ADDRESS
11,061 �o.4 &-
CITY STATE ZIP
PHONE NO.
Ner✓ orig4AtL GA- 92A6o
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4. E GINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
171 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE CC3
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CZ-1
No �?1i % ClassC6
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
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:E USE ONLY
PERMIT NO.
PLAN CHECK NO. 0 S 0 S'` l/Z,�
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls