HomeMy WebLinkAboutS2021-0137 - Permit Application62021-oi
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION �5
T CITY OF NEWPORT BEACH
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BUILDING DIVISION
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1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION m'
BLOCK
2. DESCRIPTION OF WORK A/P W ePP ®II
ESTIMATED $ VALUATION
SWIMMING POOL Lam' SPA ®" POOL FENCING ❑ DRAINAGE ❑
Check Aoorooriate box for Aoolicant
3. OWNER'S NAME
LAT
FIRST
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ADDRESSOWNER'S
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E-MAIL ADDRESS
CITY
STATE
ZIP
P ONE NO.
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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
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STATE
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ZIP
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PHONE NO.
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5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
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ZX' 3 7
AP41(of ®)1. Cowl
CITY
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STATE
ZIPO.
PHONE 1\1
C4.
T2 19 °7
:E USE ONLY
PERMIT NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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