HomeMy WebLinkAboutS2021-0195 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
s2oziBUILDING DIVISION
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PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK I21 TRACT Ira
E IP(TIONjjOF `WORK o > SS�dYI
0 ESTIMATED $ VALUATION
SWIMMING POOL SPA J POOL FENCING ❑ DRAINAGE ❑
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❑ 3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
-E CC-.,
CITY STATE ZIP
PHONE NO.
New Por4
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
44 CITY STATE �j ZIP
_ r� 7
)NE O.
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5.NTRAC OR''SNAVE
BUSINESS LICENSE%--
A LICENSE
("V/1
or-
70
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIPP
sV C� is G� �t'''al
O NO.
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:E USE ONLY
PERMIT NO.
PLAN CHECK NO. t ��y ✓V� �O� I
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls