HomeMy WebLinkAboutS2021-0123 - 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 S()4 � e<6\ C ,wIS�A Z-S;,Q 6�
19S Sl�— ESTIMATED $ VALUATION !% G c <
SWIMMING POOL ❑ SPA X POOL FENCING ❑
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3. OWNER'S NAME
LAST
FIRST
i (AA�(\ Vc.,%
A-1w
ADDRESS
OWNER'S E-MAIL
ADDRESS
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CITY
STATE
ZIP
PHONE NO.
4. ENGINEERS -NAME
LAST
FIRST
LICENSE NO.
/
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY \ /
STATE
ZIP
PHONE NO.
�C
5./CONTRACTOR'S NAME
�,Cn�
1
BUSINESS LICENSE STATE LICENSE
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7V
2
ADDRESS
No. ass
CONTRACTOR'S E-MAIL ADDRESS
p
CITY
STATE ZIP
PHONE NO.
:E USE ONLY
PERMIT NO. �jbL ft , aZ
PLAN CHECK NO. WL J, -u u 1
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appi (mv3-04).zls