HomeMy WebLinkAboutS2020-0009 - Permit Application (2)WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
r CITY OF NEWPORT BEACH �.n�O�y.�
BUILDING DIVISION sfA ao W-1
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK ftQ. \QA'r
ESTIMATED $ VALUATION
SWIMMING POOL SPA [ POOL FENCING DRAINAGE ❑
Check Annronriate box for Annlirant
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
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PHONE NO.
4. ENGINEER'S NAME LAST FIRST
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
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PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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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 $
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hormswool spa appl (rev3-04).xls N I D V W
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