HomeMy WebLinkAboutS2018-0141 - Permit Application1 P1,41 (-%Gt $
,. ae"° P WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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'eLr'��*t CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK -ff.z, Id,: -B car st_e . /
SWIMMING POOL ❑ SPA [Er
Chock Annrnnriate hox for Annlicant
P� e.,? / Pm o f
ESTIMATED $ VALUATION -tf r ?: ee7o•
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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❑ 4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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No. Class
ADDRESS
c NTRACTOR'S E-MAIL ADDRESS
CITY STATE ZCP
PHO NO.
-E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Farms\Pool spa appl (rev3-04).xis
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