HomeMy WebLinkAboutS2025-0100 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
ZZ
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK (y �° S `�� Z�
ESTIMATED $ VALUATION
12t
SWIMMING POOL [2- SPA EK POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
Ei 3. OWNER'S AME LAST FIRST
!/
?S �d (d i �I✓j
ADDRESS
OWNER'S E-MAIL ADDRESS
- �
CITY STATE ZIP
PHONE NO.
�%
f'U+1I °'lG0�z
7
/� C(J��
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONT C,T1O 'S NAME
BUSINESS LICENSE
STATE LICENSE
r
\ �.-�. ���:)
I CJZ4 U��
-:�G l 1 i
N Cla s'
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE 7 )/ ZIP
C �L ��"
HONE
OFFICE USE ONLY
PERMIT NO. SZ02S- oloo
PLAN CHECK NO. PC-2os5--////�'029 cu"L gvm l3krL iv R-) T25-3$33)
LjD ac _ ✓ / 1h,CSFt-r&k N q
POOL PIC FEE $ ( 163 Av ledta"r
DRAINAGE PIC FEE $
Forms\Pool spa appl (rev3-04).xis