HomeMy WebLinkAboutS2023-0215 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
BUILDING DIVISION
1'LMADC rKIN 1 UK IT 1'C
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK �,J L(iv R�0 i l� r 3G �/ ✓� �/ �n ✓� 5
/ ESTIMATED $ VALUATION �L OfSQ
SWIMMING
SPA
Check Appropriate box for Aoolicant
POOL FENCING ❑
DRAINAGE
3. OWNER'S NAME
LAST
FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
Z3 0 {PO rry L2 ✓"tiJ t C �C
CITY
STATE
ZIP
PHONE NO.
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
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C
-5-41-1 L 3 C-)-,6 t t 1
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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WoaO 4-t Class
CONTRACTOR'S E-MAIL ADDRESS
-ADDRESS r�✓
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CITY
STATE
ZIP
PHONE NO.
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CA—
6-17- & G75
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OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Foims'Pool soa appl (rev3-04).xls