HomeMy WebLinkAboutS2019-0174 - Permit ApplicationS2-Wq'- Ul�
o.'`" WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
BUILDING DIVISION
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1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LOT
BLOCK
TRACT
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATION
SWIMMING POOL ❑ SPA [ POOL FENCING ❑
Check Annronriate box for Annlicant
DRAINAGE LVJ
3. OWNER'S NAME LAST FIRST
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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
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ENGINEER' -MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
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5. CONTRACTOR'S NAME
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BUSINESS LICENSE
3 6�N.
STATE LICENSE
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
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614 `1 :T9 T -d
'E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls