HomeMy WebLinkAboutS2021-0052 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL ❑ SPA ❑
Check Appropriate box for Applicant
ESTIMATED $ VALUATION
POOL FENCING ❑
DRAINAGE ❑
3. OWNER'S NAME/ LAT FIRST''
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ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
rl 4. ENGINEER'S NAME LAST FIRST
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LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
LICENSE
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY% STATE ZIP
PHONE NO.
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:E 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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