HomeMy WebLinkAboutS2021-0150 - Permit Application:'""`"°A n WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION S�21 -0 (SIZE
= CITY OF NEWPORT BEACH I Z Z 1 S VI V-
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CIGIYI�4��� BUILDING DIVISION �"
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
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TRACT
2. DESCRIPTION] OF WORK ��n0 e-'-V -kV& s,• �J ? P- C. S '6 � �el �`A ;V-e
e- CC A" Y/b�l-(DY veN N ESTIMATED $ VALUATION 140,000
SWIMMING POOL ❑ SPA OK' POOL FENCING ❑ DRAINAGE (J-'
Check ADDroDriate box for Applicant
❑ 3. OWNER'S NAME LAST FIRST
W IILD
ADDRESS
OWNER'S E-MAIL ADDRESS
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STATE
PHONENO.
�CITY
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4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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ADDRESSCONTRACTOR'S
E-MAIL ADDRESS
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CITY STATE ZIP
IPHONE NO.
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:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
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DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls