HomeMy WebLinkAboutS2022-0046 - Permit Applicationoft!
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PI FARF PRINT OR TYPE
1 PROJECT ADDRESS (NOT MAILING ADDRESS)
LE(nAL DESCRIPTION ,
LOT BLOCK TRACT
2. DESCRIPTION OF WORK +1 Cp 1 1,7�LCA l7Y1 (CGTI '�/V5 ! 0 )
ESTIMATED $ VALUATION-95 , 000
J C
V bo 00 P
SWIMMING POOL] SPA POOL FENCING ElD INAGE ❑
Check Aoorooriate box for ADDlicant
3.
OWNER'S NAME
LAST
FIRST
ADDRESS
-
OWNER'S E-MAIL ADDRESS
h
J
CITY
STATE
ZIP
PHONE NO.
4.
NG NE R'S NAME
LAST
FIRST
LICENSE NO.
%cl\ .
et-
03
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
17/91-63D-49/M
5.
CONTRACTOR'S NAME
BUSINESS LICENSE
STATE/ LICENSE
`,
(v/ pD NO 0
Classe2j
IAbt5REy3s
CONTRACTOR'S E-MAIL ADDRESS
LI
7
CI Y
STATE
ZIP
PHONE NO.
171V-3q3ryQ9f
'E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
Dl17q
q 16
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls