HomeMy WebLinkAboutS2018-0194 - Permit ApplicationA540 -AZOIS
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WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
BUILDING DIVISION
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BLOCK
TRACT
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ESTIMATED $ VALUATION L,W I UQ V
SWIMMING POOL SPA POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME
LAST
FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
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
STATELICENSE
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No. ✓/ Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY
STATE
ZIP
PHONE NO,
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PERMIT NO.
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POOL P/C FEE $
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Forms\Poolspa appl(rev3-04).xls