HomeMy WebLinkAboutU2025-0167 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEW PORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJ CT AD�ESS (NOT IMAIAILING ADDRESS)
l t( I/W `ujk^�o ceK.
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL ❑
Check Appropriate box for Applicant
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ESTIMATED $ I
POOL FENCING ❑
TION o cv
DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
(4 W 2,' s 0
ADDRESS
OWNER'S E-MAIL A ESS /'
CITY STATE ZIP
PHONE NO.
210-- 625 -G3?y
4. ENGINEE 'S NAME J LAST FIRST
l/
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CO CT/O/R'S NAME
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5ST��
BUSINESS LICENSE
STATE
> LICENSE
V l � Vrl�l�
No.°1VS30 Class
/&IDDDREE%SS
CONTRACTOR'S E-MAILADDRESS
G/
CITY, STATE ZIP
`sa v���t C/o- -) S�,
PHONE NO.
%y--/-
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
UZELD-L�l
O.'
DRAINAGE P/C FEE $
FormslPool spa appl (rev3-04).xls