HomeMy WebLinkAboutS2018-0053 - Permit Application (2)SX18-4053
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WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEAC
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDS)
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LOT BLOCK TRACT
2. DESCRIPTION OF WORK _ Ate— f-, i G,J ¢e r jo o o
SWIMMING POOL q SPA ❑
Check Aoorooriate box for Aoolicant
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ESTIMATED $ VALUATION good D 0
POOL FENCING ❑ DRAINAGE ❑
E 3. OWNER'S NAME LAST FIRST
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ADDRESS
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E-MAIL ADDRESS
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C/TJ Y STATE ZIP
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PHONE NO.
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4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAM
BUSINESS LICENSE
STATE LICENSE
No. 1, 3 Class
ADDRESS ¢—
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CONTRACTOR'S E-MAIL ADDRESS
1/
CITY STATE ZIP
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1644-3
PHONE NO.
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:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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