HomeMy WebLinkAboutP2022-0285 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE �J
1. PROJECT ADDRESS (NOT MAIUN ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
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SWIMMING POOL
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IrLrvESTIMATED $ VALUATION
POOL FENCING ❑ DRAIP
3. OWNER'S NAME �A
LAST
FIRST
/-`omre�,e
ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY
STATE
ZIP PHONE NO.
933 . o�y
4. ENGINE NAME
LAST
FIRST LICELSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE TE LICENSE
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ADDRESS
a
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CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
OFFICE USE ONLY
PERMIT NO.
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PLAN CHECK NO.
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P/C FEE $
FEE $
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