HomeMy WebLinkAboutX2019-1076 - Permit Application (2)WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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CITY OF NEWPORT BEACH
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BUILDING DIVISION
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1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORKeJI J
SWIMMING POOL j SPA XK
Check Appropriate` box for Anolicant
ESTTMATED $ VALUATION
POOL FENCING ❑
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DRAINAGE ❑
D 3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
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CITY STATE
(� 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. CON-T'R`ACTOM' NAME
BUSINESS LICENSE
STATE
(LICENSE
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
LA -
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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