HomeMy WebLinkAboutS2022-0022 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION C `
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
106 W,y%kjcA L-ri,spof ach 6 Q
LEGAL DESCRIPTION
LOT BLOCK TRACT Ii o Li
2. DESCRIPTION OF WORK Q e w
a S� �
W' X + x I�- .. ESTIMATED $ VALUATION U ��
SWIMMING POOL ❑ SPA ® POOL FENCING ❑ DRAINAGE
Check Appropriate box for ADolicant
3.
OWNER'S NAME
LAST
FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
NE NO.
Qp-wabtv
e
CA',Li
rcl I- 2 -2 L f 14
4.
EN INEER'S NAME
LAST
LICENSE NO.
/FIRST
4ct,e/ I!wr
60.5-1
ADDRESS
ENGINEER'S E-MAIL ADDRESS
O
0• A r Vf-
CITY
STATE
ZIP
PHONE NO.
PwLc, \,
CA
92a0-7
7I4 -630.6111-1
❑ 5.
CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
1 0. &C oal5c4
GS
No. %iq Clas�
ADDRESS
CONTRACTOR'S E-MAIL
ADDRESS
�5
g
I
O e. O C
D w%
CITY
STATE
ZIP
PHONENO.
ALSO
giclo
CA
2656
9'Y -yy -3`z
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls