HomeMy WebLinkAboutS2020-0084 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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z CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
k)(0 Lomn Or Curow bel Mar, cA
LEGAL DESCRIPTION r \f
LOT BLOCK TRACT
2. DESCRIPTION OF
II- SWIMMING POOL LTJ SPA Vf
Check Appropriate box for Applicant
_ ESTIMATED $ VALUATION
POOL FENCING ❑
DRAINAGE ❑
3. OWNER'S NAME
LAST
FIRST
bwom
ADDRESS
OWNER'S E-MAIL ADDRESS
Poi n o Orel
lr
CITY
STATE
ZIP
PHONE NO.
❑ 4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
tic(,r
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE
ONE
n_ m
CA
N I
T V
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n 5. CONTRACTOR'S NAME
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BUSINESS LICE SE
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STATE LICENSE
3
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Ir
i /lP
No.qryClass
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY
L(J h
STATE
ZIP
�Ino(
PHONE NCV
—
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CE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xis