HomeMy WebLinkAboutS2022-0225 - Permit Applicationi hRNPOR
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PLEASE PRINT OR
LOT
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
(NOT MAILING ADDRESS)
2. DESCRIPTION OF WORK
I
BLOCK
SWIMMING POOL [t SPA ❑
Check Appropriate box for Applicant
TRACT
_ ESTIMATED $ VALUATION
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
ADDRESS
NER'S E-MAIL ADORES OWS
IN STATE ZIP
oar❑4.
ENGINEER'S NAME LAs FIRST
LON.fa
O.
ADDRESS ENGINEER'S E-MAIL ADDRESS
T 61
CITY r STATE ZIP PHONE NO.
9 280
Er . CONTRACTOR'S NAME BUSINESS LICENSE STATELICENSE
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r No.CXJ� Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
D h
CITY STATE ZIP
NO.
lz 2 v/
N3 350
OFFICE USE ONLY
PERMIT NO. 5`L(lZZ—b XR�-o12•Z8�1
PLAN CHECK NO. ''Ci%y2t^i sn ld�
POOL P/C FEE $
DRAINAGE P/C FEE $ �y�Z�, Ofe20
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