HomeMy WebLinkAboutS2021-0240 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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`G{TY OF NEWPORT BEACH
PLEASE PRINT OR TY E
BUILDING DIVISION
1. PROJECT ADDRES AILING ADDRESS)
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2. DESCRIPTION OF WORK
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ESTIMATED $ VALUATION
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SWIMMING POOL
SPA
POOL FENCING
DRAINAGE))
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
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37-7 q C,,(
CITY STATE ZIP
PHONE 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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STATE ZIP
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PHONE NO.
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5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE 2�7
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ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
6 73 AL -
CITY STATE ZIP
PHONE NO.
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,E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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