HomeMy WebLinkAboutS2023-0063 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL
pool m <.4 5 ? /Az
ESTIMATED $ VALUATION
SPA jRl' POOL FENCING ❑
Check Appropriate box for Applicant
I
DRAINAGE pe
3. OWNER'S NAME - LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY / STATE ZIP
FbfONE NO.
4. ENGINEER'S/NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE N0.
PHONE
6r��U/
❑ 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
/
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PH NE NO,
OFFICE USE ONLY S GW*
PERMIT N0. %%��% �
PLAN CHECK NO. ft zo � I %`o' j
POOL PIC FEE $
DRAINAGE PIC FEE $
Forms\Pool spa appl (rev3-04).xls