HomeMy WebLinkAboutS2022-0068 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK �� P� C U } °" 4v -1-u
%a Litt n i -{ ESTIMATED $ VALUATION
SWIMMING POOL SPA,4 POOL FENCING ❑ DRAINAGE
('hark Annrnnriate hnx for Annlicant ►,f�W1A �Xe� lm�
3. OWNER'S NAME
II LAST
FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
h� ; �,
-cV
vmr
1� >> 0, ((,ro
CITY
STATE
ZIP
PHONE NO.
`�
Uv a ��-c,, o�.,e�t
C'k
G171�2,5
55�1 t o D -- �364
® 4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
R
CA
-?WAelt..}2te1
5. CONTRACTOR'S NAME
Ski
BUSINESS LICENSE
STATE LICENSE
No.`)2-61 2,.S-C-lass
ADDRESS
CONTRACTOR'S E-MAIL
ADDRESS
19
CITY
STATE
ZIP
PHONE NO.
OFFICE USE ONLY
PERMIT NO. •6114 tZoaDa5S✓5taZ,O4,< �
PLAN CHECK NO. 1lI �-✓ '`�
POOL P/C FEE $ '
DRAINAGE P/C FEE $
11
Forms\Pool spa appl (rev3-04).xls