HomeMy WebLinkAboutS2023-0071 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAI1G G ADDRESS)
G li
LEGAL DESCRIPTION
LOT BLOCK
TRACT
2. DESCRIPTION OF WORK P 00\
ESTIMATED$'VALUATION t,
SWIMMING POOL] SPA [ POOL FENCING ❑ �jU�L ( "I DRAINAGE ❑
cI sl C1( s,") '-5
Check Appropriate box for Applicant
3. OWNER'S NAME LAST
FIRST
ADDRESS
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S
OWNER'S E-MAIL ADDRE�PH
CITY
A/w. . C�,— �ct!
STATE
C r�
ZIP
���: C
O NO.
/ , , /O%,
` . _ Z
4. ENGINEER'S NAME LAST
FIRST
LICE E NO.
Pm ,A-)�
Day.,,-\
c_ I i I k 3
ADDRESS r
r� , I�Ck �
1411f
s�
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ENGINEER'S E-MAIL ADDRESS
CITY
0 `6ek u�
STATE
ZIP
12
PHONE NO.
Ej 5. CONTRACTOR'S NAME
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:BUSINLESSLICENSE
ST TE LICENSE
JC
Ci8�7lass�
ADDRESS
I
2711
(� � h•�G�.� o �l SIC �1�
CONTRACTOR'S E-MAIL
No.
ADDRESS
CITY
STATE
ZIP
PHONE NO.
;E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Farms\Pool spa appl (rev3-04).xls
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