HomeMy WebLinkAboutS2022-0035 - Permit Application (2)'E"o° WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
'L2 �C
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK "'r' �1�—
Oyua ESTIMATED $ VALUATION
SWIMMING POOL[] SPAO POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
❑ 3.
OWNER'S NAME
LAST
FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
4.
ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
rl 5.
CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
No ) Clas;,6�
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
-7 V--D
:E USE ONLY
PERMIT NO. i EILU 21 • 094 o7z,•Ong
PLAN CHECK NO. o 4q
POOL P/C FEE $ �I
DRAINAGE P/C FEE $
Farms\Pool spa appl (rev3-04).xls