HomeMy WebLinkAboutS2022-0050 - Permit Application (2)"° WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION �o /
°n�%„° CITY OF NEWPORT BEACH �ZpZZ1005�
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING pADDRESS)cc wcA A 9e /v ��. A �
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LEGAL DESCRIPTION
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2. DESCRIPTION OF WORK �<svr oat A. I
ESTIMATED $ VALUATION dt 25; ood!
SWIMMING POOL,�!J SPA ❑ POOL FENCING ❑ DRAINAGE ❑
Check ADDroDriate box for ADDlicant
3. OWNER'S NAME LAST FIRST
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ADDRESS +
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OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
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PHONE NO.
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4. ENGINEER'S NAME 'FIRST �I�
LICENSE ���
ADDRESS
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ENGINEER'S E-MAIL AD SS
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CITY STATE ZIP
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PHONE NO.
5. C N(TRACTOR'S NAME
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/LICENSE
BUSINESS
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STATE LICENSE _Sy
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No. �o(3J31 CIa
ADDRESS
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CONTRACTOR'S E-MAIL ADDRESS t
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CITY STATE ZIP
P ONE N0.
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OFFICE USE ONLY
PERMIT NO. ��/ �j� oo r)
PLAN CHECK NO. �v `
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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