HomeMy WebLinkAboutS2022-0033 - Permit Application (2)WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
S 2o22-tb33
CITY OF NEWPORT BEACH
4
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION _
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL ❑ SPA 0
Check Appropriate box for Annlicant
N?o1 ESTIMATED $ VALUATION
o(,Y e -
POOL FENCING Cl DRAINAGE ❑
3.
OWNER'S NAME
LAST
FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
Cf 5 �1
K
CITY 0
ATE
ZIP
PHONE NO.
4.
ENGINEER'S NAM
LAST
FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5.
CONTRACTOR'S NAME
BUSINESS LICENSE STATE LICENSE
-
No.`1 6),t Classu',
ADDRE36
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
ZIP I _lPfJONE NO.^
OFFICE USE ONLY
PERMIT NO. S 2z .�L
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Farms\Pool spa appl (rev3-04).xls