HomeMy WebLinkAboutS2018-0157 - Permit Application"p 8 WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION 0944018
m CITY OF NEWPORT BEACH S?O/S O1S3
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BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS) "
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK ®7� U 1 se 2,
& A -S 6e6 TT�ESTIMATED $ VALUATION
SWIMMING POOL SPA Pl2n[ FENLlNG ❑
Ch ck A ro riate box for Applicant
DRAINAGE Egg
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3. OWNER'S YME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
CITY tj ST E ZIP
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PHONE NO.
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4. ENGINFER'S N� �ST FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
ZIP
CITYSTATE ZIP
QE/NO.
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PH ON
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5. CONTRACTOR'S NAME
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BUSIN S LICENSE
[STATE LICENSE
No,S-03 a ,3
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
TATE ZIP
HCIT S
PHONE NO.
;E USE ONLY
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PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa app[ (rev3-04).xls