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1.PROJECTADOF
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WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
'E BUILDING DIVISION
S (NOT MAILING ADDRESS)
3 C-- 914,4 .4,e
2. DESCRIPTION OF WORK �
SWIMMING POOL `ice
Check Appropriate box for AF
3. OWNER'S NAME
ADDRESS '
CITY
'\I%'� � ►.irk
ADDRESS
Z 3 0FC44"I Sri
CITY
)FF/CE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C. FEE $
Forms\Pool spa appl (rev3-04).xls
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ESTIMATED $ VALUATION
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