HomeMy WebLinkAboutS2022-0159 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
VLtAJt YKIN I UK I YFt
1. PROJECT ADDRESS (NOT MAILING ADDRESS) '
LEGAL DESCRIPTION
LOT # P-5 --? BLOCK TRACT N 22
2. DESCRIPTION OF WORK
SWIMMING POotg,
05 Poo t �S P t!a
ESTIMATED $ VALUATION
SPA 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
I
AST
'
tl�
FIrT
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
CONTRACTOR'S NAME
BUSINESS LICENSE
=STATELICENSE
ClassCti
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY
l-tti0
STATE
LP�l
ZIP
PHONE NO.
Zfgd 5l5-0GL
Z USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
C,2022, -- ) cl �2
IJ
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls