HomeMy WebLinkAboutS2022-0176 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION 57_c� �_ _ 0 1
CITY OF NEWPORT BEACH
BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
•y- CA ,(-
LE AL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK L LLp � '1±nL
- e
ESTIMATED $ VP LUATION'�I'L
SWIMMING POOL ❑ SPA POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
Gl li L C+'{' a ✓G2 t.�
ADDRESS
OWNER'S E-MAIL ADDRESS
v
CITY STATE ZIP
PHONE NO.
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
Cla
ADDRESI
CONTRACTOR'S E-MAIL ADDRESS
I
�CAG L
CITY STATE zi,5%P66NE
NO.
CE USE ONLY
PERMIT NO. ,,�j f,7LZ_
PLAN CHECK NO. 1)C'Z0Z.Z�
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls