HomeMy WebLinkAboutS2021-0213 - Permit ApplicationPLEASE PRINT OR TYPE
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH JIN %Aq
BUILDING DIVISION YWV
1. PROJECT ADDRESS (NOT MAILING ADDRESS)^
/059 OIJ CourSC Ur
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL ❑
36 Sf Sn., t
SPA
Check Appropriate box for Applicant
_ ESTIMATED $ VALUATION A,'fJDO
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NA LAST LAST FIRST
/'Ten
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
dig-c3�.9�1
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
G(ror� f
BUSINESS LICENSE
TE LICENSE
TNo.d��G�JCtass
ADDRESS
CONTRACTOR'SE-MAIL ADDRESS
71(
CITY STATE ZIP
PHONE NO.
cQ, o%C
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls