HomeMy WebLinkAboutS2022-0033 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
p4 v B
CITY OF NEWPORT BEACH s2 'Z-W4b3
BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION _
LOT BLOCK TRACT
2. DESCRIPTION OF WORK6{'
' 4 ne", 1 ESTIMATED $ VALUATION cis, 00
0" 4 v cco o� x e.
SWIMMING POOL ❑ SPA 0 POOL FENCING ❑ DRAINAGE ❑
Check ADDropriate box for Applicant
3.
OWNER'S NAME
LAST
FIRST
i
ADDRESS
OWNER'S E-MAIL ADDRESS
1
� e
CITY i
STATE
ZIP
PHONE NO.
rl 4.
ENGINEER'S NAM
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5.
CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
ADDRE S
CONTRACTOR'S E-MAIL ADDRESS
V t Cr�o c C� ter` L r 1n
STATE
ZIP I
P NE NO.
/CITY
o,v'6,n'
q {
� C -[1b
c
:E USE ONLY _
PERMIT NO.
PLAN CHECK NO. D �
POOL P/C FEE $
DRAINAGE P/C FEE $
Farms\Pool spa appl (rev3-04).xls