HomeMy WebLinkAboutS2019-0019 - Permit ApplicationeiSWrb ®6.00 -,2(910
,4 °r WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH 5'2019.0019
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NGT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK / TRACT
2. DESCRIPTION OF WORK r G 0k .1 !t G{ (2—,m,
ESTIMATED $VALUATION
N sDvz
- / T
SWIMMING POOL r SPA POOL FENCING [5 DRAINAGE
Check ADDroDriate box for Anolicant
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
p
4. gENGINEER'S NAME LAST FIRST `
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
C�ITY
PHONE NO.
pSTATE �-7ZIP
j,/�p-���/�
00
55,. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
Class�
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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a �(
CITY STATE ZIP
PHONE NO. 1 't
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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