HomeMy WebLinkAboutE2022-0323 - Permit ApplicationM. WORKSHEET FOR POOLCOMBINATION
COMBINATI ON PERMIT APPLICATION
CITY OF NEWPORT BEACH
PLEASE PRINT OR TYPE BUILDING DIVISION
1. PROJECT ADDRESS (NOT MAILING ADDRESS) obt6l
LEGAL DESCRIPTION
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BLOCK
2. DESCRIPTION OF WORK
SWIMMING POOL �
SPA
Check Appropriate box for A
3. OWNER'S NAME pplicant
LAST
ADDRESS
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CITY
4 ENGINEER'S Nl4ME
W*. L-r c-
ADDRESS
CITY
] 5. CONTRACTOR'S NAME
ADDRESSrI v l
CITY { �j
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Formskpool spa appl (rev3-04).xls
STATE
STATE
STATE
C
TRACT
_ TIMATED $ VALUAT,IION
POOL FENCING
Ej
DRAINAGE
i'S E-MAIL ADDRESS
ZI PHONE NO.
If?
LICENSE NO.
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R'S E-MAII AFFD�—
ZIP
PHONE NO.
jBUSINEPJSI�ICENSE,TATE LICENSE
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OR
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IL ADDRESS Class
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ZIP
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PHONE NO.
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