HomeMy WebLinkAboutS2019-0135 - Permit Application1747-2019
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION ROR _ 013E
°s CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK 2 ` b r S�� ^V\Q PO C)
1� c 'A �5���✓� S ESTIMATED $ VALUATION S od d
SWIMMING POOL SPA POOL FENCING ❑ DRAINAGE r
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY � S STATE ZIP
PHONE NO. � 50
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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