HomeMy WebLinkAboutS2021-0277 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH �1
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 VJ �O'�J '\ �� r'7< 13' w 't �� I r -von-5 e—'y? 5 P ✓l—
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SWIMMING POOL SPA Y� �" POCYL FENCING ❑ DRAINAGE
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3. OWNER'S NAME LAST
FIRST
ADDRESS\7
OWNER'S E-MAIL ADDRESS
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CITY
STATE
ZIP`
PHONE NO.
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4. ENGINEER'S NAME LAST
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LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
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CITY
STATE
ZIP
PHONE NO.
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5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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No.� Classes �\
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
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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