HomeMy WebLinkAboutS2022-0249 - 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
ESTIMATED $ VALUATION
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SWIMMING POOL ❑ SPA ,�q— POOL FENCING ❑ DRAINAGE ❑
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3. OWNER'S NAME
/�L LAST
FIRST
ADDRESS
'OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
a 4. ENGINEER'S NAME LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP PHONE NO.
T 1,4 F -/ /�
C/�
�'Z 2 e /`/- G 3 e,
�(55..]C.OINT.RACTOR'S
NAME
BUSINESS LICENSE STATE LICENSE
` _
No.
ADDRESS
ass
CONTRACTOR'S E-MAIL ADDRESS
CITY
vSTATE
ZIP
PHONE NO.
OFFICE USE ONLY
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls