HomeMy WebLinkAboutS2022-0231 - Permit Application"" WORKSHEET 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
I
ESTIMATED $ VALUATIONS Gc»t> 00
SWIMMING POOL ❑ SPA ❑ POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME
LAST
FIRST
J
ADDRESS
OWNER'S E-MAIL ADDRESS
Y
AT,
STATE
ZIP
PHONE NO.
4. ENGI EER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5. ONTRACTO S NAME
BUSINESS LICENSE
STATE LICENSE
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7
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY
STATE
ZIP
PHONE NO.
Ca 7? d�
—
y G
-
CE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
�2022-U �3/
Forms\Pool spa appl (rev3-04).xls