HomeMy WebLinkAboutS2020-0214 - Permit ApplicationPj aTM WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILINGADDRESS> -
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 LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
rl 4. ENGINEER'S NAME LAST FIRST
LICENSE N0.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
n 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
NcjlAq5l+Cl IS
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
OFFICE USE ONLY /�
PERMIT NO. J �oUa-i
r
PLAN CHECK N0.
POOL P/C FEE $ \�
DRAINAGE P/C FEE $
Farms\Pool spa appl (rev3-04).xls