HomeMy WebLinkAboutS2023-0201 - Permit Application" k WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK�Y� \W LYE AJLI( PIP ua� �k�(� �aXl�j Z�i1 yGfi
ESTIMATED $ VALUATION (C U "JSj a`v
SWIMMING POOL d SPA POOL FENCING ❑ DRAINAGE ❑
Ch k A ro riate box for Applicant
ec FF P
LAST
FIRST
OWNER'S NAME
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�
ADDRESS
OWNER'S E-MAIL ADDRESS
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'u` �(L,��1m11aI'lu' ,'f lCitit
CITY
STATE
ZIP PHONE NO.
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(10- 31u ) -7�75
I
4. ENGINEER'S NAME
LAST
FIRST LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS $L9 c.vj
CITY
STATE
ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
No. Class
ADDRESS
CONTRACTORS E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
�IC2022 '2E> I In
520 � • d� 1 �
C,z9 3'1�
�(Lu2�j . o3S�j
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls