HomeMy WebLinkAboutS2020-0026 - Permit Application (2)of r "a WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
PLEASE PRINT OR TYPE BUILDING DIVISION S202-0-00AP
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LOT BLOCK
2. DESCRIPTION OF WORK IV Caw
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ESTIMATED $ VALUATIO14 60,03
SPA � POOL FENCING ❑ DRAINAGE 040000,
Check Appropriate box for Applicant
3. OWNER'S NAME
LAST
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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.
No
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
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CITY
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STATE
CA
ZIP
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PHONE NO.
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5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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CITY
STATE
ZIP
PHONE NO.
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`%i 705
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'E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
1” LID nV-) 2