HomeMy WebLinkAboutS2021-0127 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
L
„pug„ CITY OF NEWPORT BEACH su%ooll'T
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL ❑ SPA ❑
Check Appropriate box for Applicant
_ ESTIMATED $ VALUATION
POOL FENCING ❑
DRAINAGE ❑
AST
3. OWNER'S NAME LAST-
ADDRESS
ADDRESS
0WN A FRISE-M LADDRESS
CITY STATE ZI
'00/
PHONE NO.
E] 4. ENGINEER'S NAME LAST FIRS
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
ST TEWCE�
No Class
ADDRESS
CONTRACTOR'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