HomeMy WebLinkAboutS2021-0048 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
d; CITY OF NEWPORT BEACH
PLEASE PRINT OR TYPE l� � " BUILDING DIVISION v�'� Vrk
AS
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT
2. DESCRIPTION OF WORK
BLOCK
SWIMMING POOL 2' SPA �5'
Check Appropriate box for Applicant
Ql-
TRACT
_ ESTIMATED $ VALUATION
POOL FENCING ❑ DRAINAGE
3. OWNER'S NAME
LAST
FIRST
ADDRESS
72,
\j AM�5
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
S NAME
4. ENGr(,Ugs
LAST
FIRST
CENS
`K
CLGt(� A L
- t
ADD ESS
FENGINLLIFS1,-MAILADDRES8
CITY
1
STATE
ZIP
PHONE NO.
15. CON�TRACTOR'
BUSINESS LICENSE
STATE LICENSE
GAME
l '�i`7i /
j
✓ �!1"GK / 00 —X,55L
No.���OyZCIassG
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE
r2
ZIP
PHONE NO. '
OFFICE USE ONLY
PERMIT NO.
,�-ZoM,Cy -B
PLAN CHECK NO.
6<3�, �202,1
POOL P/C FEE $"2
,6D
DRAINAGE P/C FEE $
�(�'� Foims\Pool spa appl (rev3-04).xls