HomeMy WebLinkAboutS2023-0086 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTIONJ
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
uhe r.b PA v� e �/h K (- n� �i� ESTIMATED $ VALUATION
SWIMMING POOL 14 SPA 2, POOL FENCING ❑ DRAINAGE fRG
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
2.v,
ADDRESS
OWNER'S E-MAIL ADDRESS
2-0 AV
CITY STATE ZIP
PHONE NO.
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4. ENGINEER'S NA/ME LAST FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S
BUSINESS LICENSE
STATE LICENSE
`NAME
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No 61f.rj Class C
ADDRES
CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIIw I
PRONE NO.
A, A 17 L� 6 4
1 7/' / - 6 el • a 27 6
;E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Fo"slPool spa appl (rev3-04).xls