HomeMy WebLinkAboutS2022-0181 - Permit Application,H\> WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
C yiAI Ln
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Z,-F %x- I -2S I &y ►I\11
C, ESTIMATED $ VALUATION �E nc>n
SWIMMING POOL SPA (� POOL FENCING ❑ DRAINAGE ❑
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3, OWNER'S NAME
-� LAST
0 [-
FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
4. ENGINEER'S NAME �/✓
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LAST �
� FIRST
LICENSE NO.
6 G
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
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STATE
ZIP
6
PHONE NO.
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5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
SZ \�
S3`1b
No. b�OI class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY
� ?�
STATE
ZIP
� 6 b
FHOE NO.
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;E USE ONLY
PERMIT NO.
PLAN CHECK NO. 2a 2 Z r 0 L,f,3 Z
POOL P/C FEE $
DRAINAGE P/C FEE $
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