HomeMy WebLinkAboutS2021-0281 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH 62021-62s/
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
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2. DESCRIPTION 0 F W 0 R K if 601 OWl Jou alfMoe L&V LAfAIA 'e!r—A
ESTIMATED $ VALUATION-A'Hi lSS - 00
SWIMMING POOL SPA M1 POOL FENCING ❑ DRAINAGE ❑
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3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE c5$
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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'E USE ONLY
PERMIT NO. �
PLAN CHECK NO. l/ ► vt) L f�
POOL P/C FEE $
DRAINAGE P/C FEE $
0 Forms\Pool spa appl (rev3-04).xls