HomeMy WebLinkAboutX2021-1018 - Permit Application (2)WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH XE02 CA �
BUILDING DIVISION
1'LCASC MIN 1 VR 1 i rC
1. PROJECT ADDRESS (N TMAILINGA DRESS)
LEGAL DESCRIPTION
LOT % BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL ❑ SPA ❑
Check Appropriate box for Applicant
ESTIMATED $ VALUATION
POOL FENCING ❑
❑ 3. OWNER'S NAME -dA LAST
IRT
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ADDRESS
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OWNER'S E-MAIL ADDRESS
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CITYk. q �ST�ATE
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(� ZIIIP� y�
li�UCIC/
PHONE NO.
4. ENGINEER'S NAME LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
J
CITY STATE
ZIP
PHONE NO.
5. CONTRACTOR'S NAME
" " �
pniwl^ BUSINESS LIICENS-ET,C1�1 STATE LICENSE
tz i i
,15 �. r�
ADPRESS
CONTRACTORS E-MAIL ADDRESS
CISSTATE
' _N&
CP Zip
P O
;E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls