HomeMy WebLinkAboutS2021-0050 - Permit Applicationr"Rr WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH 5;?Og I, o o SO
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT O, , BLOCK TRACT
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATION L+o� 6 6 6
SWIMMING POOL SPA POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Aoalicant
3. OWNER'S NAME
LAST
FIRST
PLAN CHECK NO.
POOL P/C FEE $
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY''ll
STATE
ZIP
PHONE NO.
Uy
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5. CONTRACTOR'S
BUSINESS LICENSE
STATE LICENSE
-NAME
S
Class
No.
(ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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oto
CITY
STATE
ZIP
RJHONE NO.
;E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls �� I