HomeMy WebLinkAboutX2020-0529 - Permit Applicationr.wr nR
M WORKSHEET FOR POOL COMBINATION PERMIT APPLICA31@
1 CITY OF NEWPORT BEACH3a
PLEASE PRINT OR TYPE BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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2. DESCRIPTION OF WORK `L) (?U✓ i SL� 1 -�," � S e Uc_
ESTIMATED $ VALUATION 4-5, (,o
SWIMMING POOL 0' SPA POOL FENCING ❑ DRAINAGE LT
Check Appropriate box for Applicant
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ADDRESS
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OWNER'S E-MAIL ADDRESS
CITY STATE
ZIP
PHONE NO.
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® 4. ENGINEER'S NAME LAST
FIRST
LICENSE NO.
69--6
ADDRESS
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ENGINEER'S E-MAIL ADDRESS
CITY STATE
ZIP
PHONE NO. ))
® 5. CONTRACTOR'S NAME
BUSINEESS LICENSE
STATES LICENSE
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Z
No. I U ^ o v�
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ADDRESS
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CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE
ZIP
PHONE NO.
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $ T
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls