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2. DESCRIPTION OF
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WORKSHEET FOR POOL COMBINATION PERMIITT APPLICATION
CITY OF NEWPORT BEA(5x X(oI`� oIvt
BUILDING DIVISION
NOT MAILING ADDRESS)
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SPA
Check Aonrooriate box for Aoolicant
WA -
ESTIMATED $ VALUATION 2 ��
3. OWNER'S NAME LAST FIRST
AAS
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY v STATE ZIP
PHONE NO.
4. ENGINEER'S NAMELAST FIRST
C O64— � C��
LICENSE NO.
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ADDRESS
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ENGINEER'S E-MAIL ADDRESS
CI Y STATE ZIP
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PHONE NO.
7/ 630& t 0,
5. CONTRACTOR'S NAME //� /,jun/ y2�7
Sch
BUSINESS LICENSE
STATE LIC�E�NNSEl/�`y7�
SOU 55
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N� CIS -
ADDRESS
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CONTRACTOR'S E -M IL ADDRESS
DUH reels
W� STA � Zilbi
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
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