HomeMy WebLinkAboutS2021-0057 - Permit ApplicationSUM 03-1
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WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH i
PLEASE PRINT OR TYPE BUILDING DIVISION ��
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK /�� 1��5 S�� (`�"� yy j Jrl�
SWIMMING POOL
Check Appropriate box for Applicant
ESTIMATED $ VALUATION %d
F
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
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PHONE NO.
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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
STATE LICENSE
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY ST. TE ZIP
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PHONE NO.
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls