HomeMy WebLinkAboutS2022-0101 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
o nouir no TYPE
r LLnll r
I.,PROJECT ADDRESS (NOT MAILING ADDRESS) Sa
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DE CRIPTION OF WORK ' o r; rsTi i
O( M� r I I� ESTIMATED $ VALUATION
SWIMMING POOL [ SPA14 POOL FENCING ❑ DRAINAGE ❑
Check A ro riate box for Applicant
pp v
❑ 3. OWNER'S NAME LAST b FIRST
-SAM ; N((
ADDRESS
OWNER'S E-MAIL AD
5
CITY (� STATE ZIP
PHONE N
4, ENGINEER'S NAME LAST FIRST
LICENSE NO.
-�Cf, l
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls