HomeMy WebLinkAboutS2024-0198 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPTION(q)
CITY OF NEWPORT BEACH
PLEASE PRINT OR TYPE BUILDING DIVISION
1. PROJEC (A\DDDRESS (NOT MAILINGr ADDRESS)
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LEGAL IDESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK 00L, oEt,
ESTIMATED $ VALUATION 24000
SWIMMING POOL ❑ SPA POOL FENCING El DRAINAGE
Check Appropriate box for Applica/aant
3. OWNER'S NAMw LAST
FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE
ZIP
PHONE NO.
Co 37
4. ENGINEER'S AME LAST
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FIRST
LICENSE NO.
L) PP
(a1(oJ%
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE
ZIP
i 2��
IPHONE NO.
AMtD G 1�0
5. CON CTOR'S NAME
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BUSINESS LICENSE
STATE LICENSE
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ADDRESSNo.
l
Class
CONTRACTOR'S E-MAIL ADDRESS
2`S N-L
C TY STATE
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ZIP
e8906
PHONE NO.
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OFFICE USE ONLY
PERMIT NO. y�o0 �C_ s7�z`�•��q�
PLAN CHECK NO.
POOL P/C FEE $w
DRAINAGE P/C FEE $
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