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PLEASE PRINT OR TYPE
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION x
CITY OF NEWPORT BEACH ll
BUILDING DIVISION
1. PROJECT ADDRESS N MAILINGD SS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK VVTQJ Gt
ESTIMATE $ VALUATI
SWIMMING POOL ❑ SPA POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
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O NER'S E- IL ADDRESS
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CITY
CIITY STATE G% ZIP
PHONE NO. /
4. ENGINEER'S AME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
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5. CONTRACTOR'S NAME
BUSINESS LICENSE
SlT�ArT�E LICENSE
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CONTRACTOR'S E-MAIL ADDRESS
CITYSTATE ZIP
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PHONE NO. %v -
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FFICE USE ONLY
PERMIT NO.k'�lY
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls