HomeMy WebLinkAboutS2021-0044 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
IN CITY OF NEWPORT BEACH 'f r
BUILDING DIVISION
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1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SPA [vt'
Check Appropriate box for Applicant
ESTIMATED $ VALUATION k?V O4)6
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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4.ENGINEER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
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CITY STATEZIP
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PHONE O.
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5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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ADDRESS O r
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CONT ACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP
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;E USE ONLY
PERMIT NO. ( V 1
PLAN CHECK NO. ON 0 �
POOL P/C FEE $
DRAINAGE P/C. FEE $
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