HomeMy WebLinkAboutS2020-0192 - Permit ApplicationV,
G1020 --Wit
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
DESCRIPTION
119]11
2. DESCRIPTION OF WORK
SWIMMING POOL ❑
BLOCK
m
Check ADDroariate box for Anolicant
_ ESTIMATED $ VALUATION
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
OZJ�✓^/ V C��/q
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
/M✓"aO!2�r Aw /ST1?17,1
PHONE NO.
�C
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO. w�
�w 1
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
N�w
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls