HomeMy WebLinkAboutS2024-0059 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
BUILDING DIVISION
YLCAAC VKIN I UK I YFL
1. PRO ECT ADDRESS (NOT MAILING ADDRESS)
2.+ A
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OFF WORK 54
�' ESTIMATED $ VALUATION O o e
SWIMMING POOL ❑ SPA F�f- POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3.
OWNNEE/R'S NAME
LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY
8TATE ZIP
PHONE NO.
/
4.ENGINEER'S
NAME
LAST FIRST
LICENSE NO.
Al
-Z-11-11
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
ZIP
PHONE NO.
/`4i/lc�
jSTATE
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5.
CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE ZIP
PHONE NO.
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
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DRAINAGE P/C FEE $
Forms\Pool soa aDDI (rev3-041.x1s