HomeMy WebLinkAboutS2022-0174 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
EGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATION' ' 1 < < L
SWIMMING POOL SPA POOL FENCING ❑ DRAINAGE ❑
Check Annronriate box for Applicant
3.OJWNER'S NAME
LAST
FIRST
!
� � (a\\a 0
ADDRESS
OWNER'S E-MAIL ADDRESS
(n c..A!
CITY
(\ �
C 6 �A
STATE
Q-i l
ZIP
PHONE NO.
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
ir\,l
1
Lr l .-✓
CITY
STATE
ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
Cw L,-I CF tk• it
N L-
No. Class
ADDRESS
OON I RACTOR'S E-MAIL
ADDRESS
V~a���.
CITY
STATE
ZIP
PHONE NO,
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL PIC FEE $
s_.-wLy" 0) )7
k bt, �L- it c•
DRAINAGE PIC FEE $
Forms\Pool spa appl (rev3-04).xls