HomeMy WebLinkAboutS2019-0100 - Permit Application�WreB° WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION 5,zolt?- 0/00
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CITY OF NEWPORT BEACH
PLEASE PRINT OR TYPE BUILDING DIVISION
1: PROJECT ADORES$ (NOT MAILING ADDRESS)
LEGAL D&ESCRISCRI SrPTION c3esc 1, 7 Z6'1') C)
LOT BLOCK
TRACT
2. DESCRIPTION OF WORK �C ° /Sse� S ,5 �"a( G�� �S
ESTIMAT D $ A UA ION ro
SWIMMING POOL' SPA POOL FENC
cc DRAINAGE ❑
Check Appropriate box for Applicant
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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0 4. ENG INEER'SNAME LAST FIRST
LICENSE NO.
ADORE$$ ENGINEER'S E-MAIL ADDRESS
CITY STATE
ZIP PHONE NO.
0 5. CONTRACTOR'S NAME BUSINESS LIC NS STATE LICENSE
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ADDRESS �� No. Class
2 2 ? �CONTR l pR S - AIL ADDRESS
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CITY STATE
ZI PHONE NO.
OFFICE USE ONLY
PERMIT NO. C ¢
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls