HomeMy WebLinkAboutS2019-0141 - Permit Application(1)
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION totq.- b�L( C
PI FOSF_ PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK 546&fff"'
SWIMMING POOL SPA
:heck Appropriate box for Applicant
ESTIMATED $ VALUATION �:T I—,%
POOL FENCING ❑ DRAINAGE ❑
3. OWNER NAME FIRST
LASTJ��
ADDRESS
OWNER'S E-MAIL ADDRESS
STATE ZIP
PHONE NO.
ky*�
4ENGINEER'S NAME
LAST FIRST
LICENSE NZ—P���
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE ZIP
fl S-49 7
PHONE NO.
6�1K
5./ CONTRACTOR'S IyAME
BUSINESS LICENSE
STATE LICENSE
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CI Y
�TE ZIP
PHONE N0.
OFFICE USE ONLY
NO.
11011
PERMIT
�j
PLAN CHECK NO.
1/v
POOL P/C FEE $
✓
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls � ,q 6 ✓mCy7