HomeMy WebLinkAboutS2022-0097 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
` CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL 1�f SPA OX
ncork AnnrnnriatP hnr fnr Annlicant
ESTIMATED $ VALUATION / 5.10,w J�`
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME
LAST
FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
Alfui
6 6D
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
haC
1
q�2
ADDRESS
E-MAIL ADDRESS
o
fAi A ve
JENGINEgR'S
CITY
STATE
ZIP
IPHONE NO.
k-
vv
M
92W`
I 7/ - 3d_6 o�
5. ONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
C 7]
/ �R O Class CZ -
No b
ADDRESS
CONTRACTOR'S E-MAIL
ADDRESS
c
, c rc. 4
CITY
QI1CA—
STATE
ZIP
PHONE NO.
-63
OW
q2 2QZa—
�3i3
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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Forms\Pool spa appl (rev3-04).xls