HomeMy WebLinkAboutS2022-0137 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS) u• ,
j�r2� ,' ,�i/% I C C
m
LOT BLOCK TRACT
2. DESCRIPTION OF WORK AV C-tL� ��� Z '
SWIMMING POOL SPA t7
Check Appropriate box for Applicant
ESTIMATED $ VALUATION
POOL FENCING ❑
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
tOWNER'S
ADDRESS
E-MAIL ADDRESS
,
CIT STATE ZIP
PHONE NO.
�l
4.ENGINEER'S NAME LAST FIRST
LICENSE NO.
La
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO,
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
i
No. Class
ADDRESS+
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO. '
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
>( s�
DRAINAGE P/C FEE $ I✓ G 4� C% `� v
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Forms\Pool spa appl (rev3-04).xls