HomeMy WebLinkAboutS2022-0161 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH sZp22'-C)I(JQ
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK kt5�e �"^�^^ rn Pi ljn5 ?ki -Sf n z 7c�) ,7E�ST IMATED $ VALUATION Tq�
4�/OoO
17-
SWIMMING POOL Z SPA P POOL FENCING ❑
Check Appropriate box for Applicant
DRAINAGE ❑
3. OWNER'S NAME
LAST
FIRST
ADDRESS -
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
Nta,R,T
CA
-?
71I't—III 5.-31Ll
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
lNo.
q( i2,:,j
Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
C-A
ZIP
q2G I
PHONE NO.
1W---16-7- 7G7;
OFFICE USE ONLY
PERMIT NO.
G Z_
PLAN CHECK NO.
�ZZ % �2
/ t
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls