HomeMy WebLinkAboutS2022-0058 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATIONVbe
f CITY OF NEWPORT BEACH
BUILDING DIVISION Intl
PLEASE PRINT OR TYPE v VV
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION kv;�4 4Z5 2 Ao- Q C
LOT BLOCK J CT
Q
SWIMMING POOL 0
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SPA Ie POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
❑ 3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONENO.
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4. ENGINEER'S NAME LAST IRS-
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
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once PMA- . co
CITY STATE ZIP
PHONE NO.
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❑ 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATELICENSE
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No. �6q Class
ADDRESS
CONTRACTOR'S E-MAIL DDRESS
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CITY STATE ZIP
PHONE NO.
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OFFICE USE ONLY Xlek�y
PERMIT NO.
PLAN CHECK NO. Okild"
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POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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