HomeMy WebLinkAboutS2021-0079 - Permit Application (2)WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
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1. PROJECT ADDRESS (Nor MAILING ADDRESS)
2. DESCRIPTION OF WORK `OO L
SWIMMING POOL SPA
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_ ESTIMATED $ VALUATII
POOL FENCING ❑
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DRAINAGE ❑
3. OWNER'S NAME
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LAST
FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP PHONE NO.
4. ENGINEER'S NAME
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LAST
FIRST LICENSE NO.
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ADDRESS
ENGINEER'S 'EMAIL
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CITY
STATE
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5. C NTRACTOR'S NAME
BUSINESS LI ENSE STATE LICENSE
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ADDRESS
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No. ClassUcc,
CONTRACTOR'S E-MAIL ADDRESS
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CITY
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STATE
ZIP 'PHONE NO.
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OFFICE USE ONLY
PERMIT NO.
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PLAN CHECK NO.
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POOL P/C FEE $
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DRAINAGE P/C FEE $
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