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J WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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M: 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 ❑ SPAX,
Check Awrooriate box for Annlicant
_ ESTIMATED $ VALUATION
POOL FENCING ❑
DRAINAGE ❑
❑ 3. OWNER'S NAME��
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ADDRESS
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OWNER'S E-MAIL ADDRESS
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CITY
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STATE
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ZIP
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PHONE NO.
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❑ 4. ENGINEER'S NAME
LAST
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FIRST
LICENSE NO.
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ADDRESS
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ENGINEER'S E-MAIL ADDRESS
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CITY
STATE
ZIP
PHONE NO.
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❑ 5. CONTRACTOR'S NA M7k^
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BUSINESS LICENSE
STATE L CENSE
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ADDRESS
TRACTOR'S E-MAIL ADDRESS
CITY
STATE
ZIP
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
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