HomeMy WebLinkAboutS2023-0158 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLtASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
f7$/ fool-,F
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK �t'f � �- �fG # Sf'fj. fti> LL lac"V P,/rJ-A /A)
L-LD LlS-(INC* I N ESTIMATED $ VALUATION �' � i 75-6
SWIMMING POOL SPA POOL FENCING ❑ DRAINAGE ❑
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3. OWNER'S NAME
LAST
FIRST
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-PuPT->y
ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY
STATE
ZIP
PHONE NO.
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(,--
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4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE G27
4
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY
STATE
ZIP PHONE NO. com
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(OFFICE USE ONLY
PERMIT NO. r S Z0Z3 s Q 1 SA
PLAN CHECK NO. _pCO2®Z3 e 1 a %
POOL P/C FEE $
DRAINAGE P/C FEE $
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