HomeMy WebLinkAboutS2022-0135 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEAL.:
BUILDING DIVISION
PLEASE PRINT OR TYPE
I 1. NKUJEU I 'AIJUKtJS (NOT MAILING ADDRESS)
P i t - 3vwK l--7- E
LOT BLOCK
TRACT
DEiSCRIPTIN OF WORK S✓P I
ESTIMATED $ VALUATION
SWIMMING POOL SPA Ly POOL FENCING ❑
Check Appropriate box for Applicant
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
c — `t
ADDRESS
I CY �I �,Wa S,r T(6a, L
OWNER'S E-MAIL ADDRESS
n '' J 7 �
CITY STATE ZIP
Tt
PHONE NO {LJ,�, tju7
4. ENGINEER'S NAME LAST FIRST p� _
Co 161 �L 2-i 1\� � J
LICENSE NO.
714
,L/ l� iL
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CIT/pY, I I� � STATE ZIP
PHONE NO / .
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE .. J
-` ^c���;
L
Vl�
-A ,� -
No. Class
ADDRESS
DAL :O`-P�J ')D ITS'- l� i75
CONTRACTOR'S E-MAIL ADDRESS
�ftN
CITY 1 STATE ZIP
PHONE N
OFFICE USE ONLY � / ov)6 - o3 65
PERMIT NO. �iii �JJ PL(-j Z - o i q -a-
PLAN CHECK NO.
POOL PIC FEE $ �J� l9
yoo�
DRAINAGE PIC FEE $
Forms\Pool spa appl (rev3-04).xls