HomeMy WebLinkAboutX2017-3854 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
69 vut c
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK ilCL4 U 4AItl-4— 14 1
1
ESTIMATED $VALUATION
SWIMMING POOL ❑ SPA ❑ POOL FENCING ❑
Check Appropriate box for ADDlicant
DRAINAGE ❑
3. OWNER''NAME
LAST
FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
qAIL
CITY
STATZIP
P ONE NO.
N -
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE STATE LICENSE
Clas
ADDRESS
CONTRACTOR'S E-MAIL ADDRESSIL&
A^^
-cb `
CI q
STATE,
ZIP � PHQNE� NO(J�� I
OFFICE USE ONL Y
PERMIT NO,
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls