HomeMy WebLinkAboutS2020-0138 - Permit ApplicationYty`" rk'` WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH��)
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT DDRESS (NOT MAILING ADDRESS)—
G 4",
LEGAL DESCRIPTION j
LOT BLOCK TRACT
1
2. DES RIPTION OF WORK
Y
_ •. / jam,.
SWIMMING POOL ❑ SPA <"
Check Appropriate box for Applicant
ESTIMATED $ VALUATION
POOL FENCING ❑
DRAINAGE ❑
O�NER'S NA LAST FIRST .
ADDRESS
7ER:'S E-MAIL ADDRESS ,
low -
CITY sT,/� TE ZIP
fC
o7z
PHONE NO.
f O.Iro
® 4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls